Review Question - QID 212829

A 67-year-old man presents to the clinic for bloody urine for 1 day. He denies any recent trauma, medication changes, abnormal ingestion, discharge, or pain associated with his symptoms. He endorses increased urinary frequency and urgency within the past week. His past medical history is significant for diabetes, asthma, and a past parasitic infection when he visited Egypt 10 years ago. He also had an episode of idiopathic uveitis that was resistant to standard therapy and was subsequently treated with a 2-week-course of cyclophosphamide. A urinalysis is unremarkable. A cystoscopy is performed and its finding is shown in Figure A. Which of the following most likely led to this patient’s condition?