Clinical Updates on Birt-Hogg-Dubé Syndrome and Atypical Presentations: Diagnosis and Management

Clinical Updates on Birt-Hogg-Dubé Syndrome and Atypical Presentations: Diagnosis and Management

Authors

  • Madeline Brown University of Maryland school of Medicine
  • Jacqueline Hwang University of Maryland School of Medicine, Department of Dermatology
  • Amor Khachemoune SUNY Downstate and Veterans Affairs Hospital

Keywords:

Birt-Hogg-Dubé syndrome, Mucous membrane pemphigoid, Cicatricial pemphigoid, Autoimmune bullous dermatoses, Pemphigoid antibodies

Abstract

Introduction: Birt-Hogg-Dubé (BHD) syndrome is a rare hereditary genodermatosis associated with a mutation in the folliculin (FLCN) gene. Diagnostic criteria for this disease were first established in 2009.

Objectives: This review aimed to reassess current guidelines by taking into consideration incomplete forms of the syndrome, as patients may present clinical features of BHD without a detectable FLCN gene mutation.

Methods: Recent findings of new germline mutations and associated phenotypes were analyzed to evaluate the adequacy of existing diagnostic criteria.

Results: Researchers have come across novel germline mutations and phenotypes, revealing that some individuals with features of BHD may not carry the FLCN mutation. These findings suggest the existence of incomplete or atypical presentations of the syndrome.

Conclusions: Individuals who share any characteristics of BHD should be screened, as patient outcomes depend heavily on early detection. Updated diagnostic approaches are needed to account for the broader phenotypic spectrum of the disease.

References

Schmidt LS, Linehan WM. FLCN: The causative gene for Birt-Hogg-Dubé syndrome. Gene. 2018;640:28-42. DOI:10.1016/j.gene.2017.09.044. PMID: 28970150.

Fenner A. Differential mTORC1 pathways in BHD. Nat Rev Urol. 2020;17(9):485-485. DOI:10.1038/s41585-020-0364-2

Schmidt LS, Vocke CD, Ricketts CJ, et al. PRDM10 RCC: A Birt-Hogg-Dubé-like Syndrome Associated With Lipoma and Highly Penetrant, Aggressive Renal Tumors Morphologically Resembling Type 2 Papillary Renal Cell Carcinoma. Urology. 2023;179:58-70. DOI:10.1016/j.urology.2023.04.035. PMID: 37331486.

Zong D, Li J, Liu X, Guo T, Ouyang R. Identification of a Novel Pathogenic Folliculin Variant in a Chinese Family With Birt–Hogg–Dubé Syndrome (Hornstein-Knickenberg Syndrome). Front Genet. 2020;11:565566. DOI:10.3389/fgene.2020.565566

Schmidt LS, Linehan WM. Molecular Genetics and Clinical Features of Birt-Hogg-Dubé-Syndrome. Nat Rev Urol. 2015;12(10):558-569. DOI:10.1038/nrurol.2015.206. PMID: 26334087.

Belgam Syed SY, Lipoff JB, Chatterjee K. Acrochordon. In: StatPearls. StatPearls Publishing; 2023. Accessed January 22, 2024. http://www.ncbi.nlm.nih.gov/books/NBK448169/

Muller ME, Daccord C, Taffé P, Lazor R. Prevalence of Birt-Hogg-Dubé Syndrome Determined Through Epidemiological Data on Spontaneous Pneumothorax and Bayes Theorem. Front Med (Lausanne). 2021;8:631168. DOI:10.3389/fmed.2021.631168. PMID: 33987191.

Boone PM, Scott RM, Marciniak SJ, Henske EP, Raby BA. The Genetics of Pneumothorax. Am J Respir Crit Care Med. 2019;199(11):1344-1357. DOI:10.1164/rccm.201807-1212CI. PMID: 30681372.

Daccord C, Good JM, Morren MA, Bonny O, Hohl D, Lazor R. Birt-Hogg-Dubé syndrome. Eur Respir Rev. 2020;29(157):200042. DOI:10.1183/16000617.0042-2020. PMID: 32943413.

Ouellette DR, Parrish S, Browning RF, et al. Unusual causes of pneumothorax. J Thorac Dis. 2014;6(Suppl 4):S392-S403. DOI:10.3978/j.issn.2072-1439.2014.08.07. PMID: 25337394.

Zbar B, Alvord WG, Glenn G, et al. Risk of renal and colonic neoplasms and spontaneous pneumothorax in the Birt-Hogg-Dubé syndrome. Cancer Epidemiol Biomarkers Prev. 2002;11(4):393-400. PMID: 11927500.

Adley BP, Smith ND, Nayar R, Yang XJ. Birt-Hogg-Dubé syndrome: clinicopathologic findings and genetic alterations. Arch Pathol Lab Med. 2006;130(12):1865-1870. DOI:10.5858/2006-130-1865-BSCFAG

Perez-Ordonez B, Hamed G, Campbell S, et al. Renal oncocytoma: a clinicopathologic study of 70 cases. Am J Surg Pathol. 1997;21(8):871-883. DOI:10.1097/00000478-199708000-00001. PMID: 9255250.

Alaghehbandan R, Przybycin CG, Verkarre V, Mehra R. Chromophobe renal cell carcinoma: Novel molecular insights and clinicopathologic updates. Asian J Urol. 2022;9(1):1-11. DOI:10.1016/j.ajur.2021.11.010. PMID: 35198391.

Gupta S, Kanwar SS. Biomarkers in renal cell carcinoma and their targeted therapies: a review. Explor Target Antitumor Ther. 2023;4(5):941-961. DOI:10.37349/etat.2023.00175. PMID: 37970211.

Ruiz V, Bujan L, Kalfayan PG, Seehaus A, Carboni Bisso I, Las Heras M. Hemoptysis after COVID-19 and the importance of differential diagnosis: Birt-Hogg-Dubé syndrome. Medicina (B Aires). 2023;83(2):311-314.

Lertdetkajorn K, Haw J, Paysour JE. THU514 Atypical Presentation Of Birt-Hogg-Dubé Syndrome With Poorly Differentiated Follicular Thyroid Cancer And Paraganglioma. J Endocr Soc. 2023;7(Suppl 1):bvad114.2142. DOI:10.1210/jendso/bvad114.2142

Balakumar R, Farr MRB, Fernando M, Jebreel A, Ray J, Sionis S. Adult-Type Rhabdomyoma of the Larynx in Birt–Hogg–Dubé Syndrome: Evidence for a Real Association. Head Neck Pathol. 2018;13(3):507-511. DOI:10.1007/s12105-018-0922-6. PMID: 29744825.

Dong L, Gao M, Hao W jing, et al. Case Report of Birt–Hogg–Dubé Syndrome. Medicine (Baltimore). 2016;95(22):e3695. DOI:10.1097/MD.0000000000003695. PMID: 27258496.

Palmirotta R, Savonarola A, Ludovici G, et al. Association Between Birt Hogg Dubé Syndrome and Cancer Predisposition. Anticancer Research. 2010;30(3):751-757. PMID: 20392993.

Woodford MR, Andreou A, Baba M, et al. Seventh BHD international symposium: recent scientific and clinical advancement. Oncotarget. 2022;13:173-181. DOI:10.18632/oncotarget.28176

Nowsheen S, Hand JL, Gibson LE, el-Azhary RA. Melanoma in a patient with previously unrecognized Birt-Hogg-Dubé syndrome. JAAD Case Rep. 2019;5(11):947-952. DOI:10.1016/j.jdcr.2019.08.018. PMID: 31687461.

Patel R, Wesenberg J, Brammeier J. Fibrofolliculomas in Birt-Hogg-Dubé syndrome treated with nonfractionated ablative CO2 laser. JAAD Case Rep. 2023;40:96-98. DOI:10.1016/j.jdcr.2023.08.026. PMID: 37771352.

Menko FH, van Steensel MAM, Giraud S, et al. Birt-Hogg-Dubé syndrome: diagnosis and management. Lancet Oncol. 2009;10(12):1199-1206. DOI:10.1016/S1470-2045(09)70188-3. PMID: 19959076.

Toro JR, Wei MH, Glenn GM, et al. BHD mutations, clinical and molecular genetic investigations of Birt–Hogg–Dubé syndrome: a new series of 50 families and a review of published reports. J Med Genet. 2008;45(6):321-331. DOI:10.1136/jmg.2007.054304. PMID: 18234728.

Shvartsbeyn M, Mason AR, Bosenberg MW, Ko CJ. Perifollicular fibroma in Birt-Hogg-Dubé syndrome: an association revisited. J Cutan Pathol. 2012;39(7):675-679. DOI:10.1111/j.1600-0560.2012.01929.x

Nam JH, Min JH, Lee GY, Kim WS. A Case of Perifollicular Fibroma. Ann Dermatol. 2011;23(2):236-238. DOI:10.5021/ad.2011.23.2.236

Zamora EA, Aeddula NR. Tuberous Sclerosis. In: StatPearls. StatPearls Publishing; 2023. Accessed December 2, 2023. http://www.ncbi.nlm.nih.gov/books/NBK538492/

Starink TM, Houweling AC, Doorn MBA van, et al. Familial multiple discoid fibromas: A look-alike of Birt-Hogg-Dubé syndrome not linked to the FLCN locus. Journal of the American Academy of Dermatology. 2012;66(2):259.e1-259.e9. DOI:10.1016/j.jaad.2010.11.039. PMID: 21794948.

van de Beek I, Glykofridis IE, Tanck MWT, et al. Familial multiple discoid fibromas is linked to a locus on chromosome 5 including the FNIP1 gene. J Hum Genet. 2023;68(4):273-279. DOI:10.1038/s10038-022-01113-1. PMID: 36599954.

Dubois A, Rajan N. CYLD Cutaneous Syndrome. In: Adam MP, Feldman J, Mirzaa GM, Pagon RA, Wallace SE, Amemiya A, eds. GeneReviews®. University of Washington, Seattle; 1993. Accessed November 18, 2024. http://www.ncbi.nlm.nih.gov/books/NBK555820/

Garofola C, Jamal Z, Gross GP. Cowden Disease. In: StatPearls. StatPearls Publishing; 2024. Accessed November 18, 2024. http://www.ncbi.nlm.nih.gov/books/NBK525984/

Downloads

Published

2026-01-30

How to Cite

1.
Brown M, Hwang J, Khachemoune A. Clinical Updates on Birt-Hogg-Dubé Syndrome and Atypical Presentations: Diagnosis and Management. Dermatol Pract Concept. 2026;16(1):5099. doi:10.5826/dpc.1601a5099

Share