A 54-Year-Old Sudanese Immigrant Is Evaluated for Several Months of Intermittent

A 54-year-old Sudanese immigrant is evaluated for several months of intermittent dysuria and gross hematuria.  The patient notes that he passes blood at the end of urination but has no associated pain.  Cystoscopy reveals erythematous areas in the bladder mucosa.  Multiple biopsies are taken from the affected sites; histopathological findings are shown in the image below. Which of the following most likely predisposed this patient to his current condition?

A) Chronic urinary tract obstruction
B) Contaminated water exposure
C) Cytotoxic immunosuppressant use
D) Extensive cigarette smoking
E) Urea-splitting bacterial infection

Correct Answer:

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