Principle of Occam’s razor in differential diagnosis. A series of clinical cases

E.V. Kulchavenya^1–3, D.P. Kholtobin^1,3, E.M. Zhukova¹ 

¹Novosibirsk Research Institute of Tuberculosis, Novosibirsk

²Novosibirsk State Medical University, Novosibirsk

³AVICENNA Medical Center, Novosibirsk 

Genitourinary tuberculosis (GUTB) over the past 14 years has fallen from the first position in the structure of the extrapulmonary tuberculosis prevalance to the second. This led to the formation of a misperception about the relevance loss concerning GUTB, but it does not correspond to reality. In recent years, several diseases have been diagnosed more and more commonly in one patient, showing mutually aggravating effect of concomitant pathologies.

The article provides the following several clinical cases. Patient A., female, 48 years old, complained of pain in the right kidney and frequent urination. Urolithiasis and secondary pyelonephritis was diagnosed 25 years ago. Tuberculosis was suspected only in the microcystis manifestation. Patient G., male, 54 years old, had cavernous pulmonary tuberculosis. The penile ulcer was initially regarded as tuberculosis of the penis. The lack of effect from antitubercular therapy prompted to perform a marginal biopsy, histologically confirmed cancer. Patient T., male, 33 years old, diagnosed with tuberculosis of the respiratory organs and the mass in the left kidney, which was also initially attributed to the role of tuberculosis. During antitubercular chemotherapy, nephrectomy was performed, and kidney cancer was histologically detected.

GUTB has no pathognomonic symptoms. Clinical picture and laboratory manifestations, along with the high oncological vigilance, can make think about cancer first. Nonspecific infections of the genitourinary system and malignant tumors can precede tuberculosis, accompany it or develop after the tuberculosis treatment. Besides, multimorbidity makes it difficult to diagnose GUTB in a timely manner.

Keywords: genitourinary tuberculosis, kidney cancer, penile cancer, urolithiasis, diagnosis.

For citation: Kulchavenya E.V., Kholtobin D.P., Zhukova E.M. Principle of Occam’s razor in differential diagnosis. A series of clinical cases. RMJ. 2022;7:42–45.