A 48-Year-Old Man Who Just Relocated to the United States

A 48-year-old man who just relocated to the United States visits his doctor complaining of several skin problems. Physical examination reveals a few well-defined, hypopigmented lesions with decreased sensitivity on the skin of his lower limbs. Following confirmation of the leprosy diagnosis, the patient is subjected to further tests to assist determine the severity of his condition. A huge indurated nodule develops after an intradermal injection of heat-killed Mycobacterium leprae. Which of the following additional findings is most likely to be observed in the patient?

A) Blood smears positive for mycobacteria
B) High serum level of protective antimycobacterial antibodies
C) Inactivated macrophages
D) Increased interleukin-2 and interferon-gamma in skin lesions
E) Numerous acid-fast bacteria in skin lesions