A 42-year-old lady arrives at the clinic complaining of a lesion on the left side of her chest. The lesion formed some months ago and is gradually growing in size, occasionally seeping blood. The patient had a living-donor kidney transplant five years ago for end-stage renal illness caused by IgA nephropathy. She is also hypothyroid as a result of Hashimoto thyroiditis. Tacrolimus, mycophenolate, low-dose prednisone, and levothyroxine are among the medications used. Vital indicators are typical. A 1 2 cm crusty lesion over the midsternum is discovered on physical examination. The lesion is biopsied, and the histopathology findings are shown in the exhibit.
Which of the following most likely contributed to the development of this patient's skin lesion?
A) Decreased immune surveillance
B) Decreased peripheral T-cell tolerance
C) Decreased telomerase activity
D) Increased differentiation of monocytes into macrophages
E) Increased expression of MHC class I on abnormal cells
Correct Answer:
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