Microbiology - USMLE Step 1 - Exam - Qbank 1
A 28-year-old man comes to the physician because of a 1-year history of pain with urination that has increased in severity during the past month. He also has had episodes of blood in his urine during the past 5 years. He lived in sub- Saharan Africa until he came to the USA 6 months ago for graduate school. His temperature is 38°C (100.4°F), pulse is 80/min, respirations are 16/min, and blood pressure is 110/84 mm Hg. Physical examination shows suprapubic tenderness. Laboratory studies show:Hemoglobin: 12.3 g/dLHematocrit: 37% Leukocyte count: 13,400/mm3Segmented neutrophils: 65%Bands: 5% Eosinophils: 5%Lymphocytes: 22%Monocytes: 3%SerumUrea nitrogen: 75 mg/dLCreatinine: 3.8 mg/dLUrine Blood: 3+RBC: 200/hpfWBC: 100/hpfRBC casts: absentWBC casts: absentImaging studies show bilateral hydroureter and hydronephrosis and foci of calcification in the region of the bladder. A biopsy specimen of the bladder shows marked chronic inflammation with fibrosis and scattered granulomas. Which of the following best explains the biopsy findings?
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