Case Report  Open Access


Allergy Asthma Respir Dis. 2015 May;3(3):232-235. Korean.
Published online May 29, 2015.  https://doi.org/10.4168/aard.2015.3.3.232
© 2015 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology
Birt-Hogg-Dubé syndrome incidentally diagnosed during asthma management
Jun Ho Kim,1 Kyung Hee Park,1,2 Dong Hyun Kim,1 Young Joo Kim,1 Jung-Won Park,1,2 Hye Jung Park,1,2 Jin-Sung Lee,3 Jong Rak Choi,4 and Jae-Hyun Lee1,2
1Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
2Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea.
3Division of Clinical Genetics, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
4Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.

Correspondence to: Jae-Hyun Lee. Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: +82-2-2228-1987, Fax: +82-2-393-6884, Email: jhleemd@yuhs.ac
Received March 23, 2015; Revised April 08, 2015; Accepted April 16, 2015.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).


Abstract

Birt-Hogg-Dubé (BHD) syndrome is an autosomal dominant hereditary disorder characterized by 3 clinical manifestations, including skin fibrofolliculomas, multiple pulmonary cysts with or without spontaneous pneumothorax, and spontaneous renal tumor. A 60-year-old Korean male who had suffered from bronchial asthma incidentally diagnosed with multiple pulmonary cysts by computed tomography during a regular follow-up. Genetic studies revealed folliculin gene mutation that was a confirmative finding of BHD syndrome. Although this case showed no cutaneous manifestations or renal abnormality, genetic studies of his family and regular follow-up are recommended.

Keywords: Birt-Hogg-Dubé syndrome; Human FLCN protein; Kidney neoplasms; Asthma

Figures


Fig. 1
High resolution computed tomography of chest reveals multiple lung cysts.
Click for larger imageDownload as PowerPoint slide


Fig. 2
FLCN gene analysis revealed gene mutation at exon 11 on chromosome 17.
Click for larger imageDownload as PowerPoint slide

References
1. Birt AR, Hogg GR, Dube WJ. Hereditary multiple fibrofolliculomas with trichodiscomas and acrochordons. Arch Dermatol 1977;113:1674–1677.
2. Roth JS, Rabinowitz AD, Benson M, Grossman ME. Bilateral renal cell carcinoma in the Birt-Hogg-Dubé syndrome. J Am Acad Dermatol 1993;29:1055–1056.
3. Toro JR, Glenn G, Duray P, Darling T, Weirich G, Zbar B, et al. Birt-Hogg-Dubé syndrome: a novel marker of kidney neoplasia. Arch Dermatol 1999;135:1195–1202.
4. Schmidt LS, Warren MB, Nickerson ML, Weirich G, Matrosova V, Toro JR, et al. Birt-Hogg-Dubé syndrome, a genodermatosis associated with spontaneous pneumothorax and kidney neoplasia, maps to chromosome 17p11.2. Am J Hum Genet 2001;69:876–882.
5. Menko FH, van Steensel MA, Giraud S, Friis-Hansen L, Richard S, Ungari S, et al. Birt-Hogg-Dubé syndrome: diagnosis and management. Lancet Oncol 2009;10:1199–1206.
6. Kim EH, Jeong SY, Kim HJ, Kim YC. A case of Birt-Hogg-Dubé syndrome. J Korean Med Sci 2008;23:332–335.
7. Yoon SB, Park CK, Kang MK, Lee SJ, Han DH, Ki CS, et al. A case of Birt-Hogg-Dube syndrome diagnosed by a folliculin gene mutation. Korean J Med 2011;81:102–106.
8. Bae HJ, Woo OH, Yong HS, Kang EY, Kim HK, Choi YH, et al. Spontaneous pneumothorax in Birt-Hogg-Dube syndrome: two case reports. J Korean Soc Radiol 2011;64:39–43.
9. Seo M, Lim DH, Song JS, Park CS, Chae EJ, Song JW. Two cases of Birt-Hogg-Dube syndrome with pulmonary cysts. Korean J Med 2014;87:477–483.
10. Zbar B, Alvord WG, Glenn G, Turner M, Pavlovich CP, Schmidt L, et al. Risk of renal and colonic neoplasms and spontaneous pneumothorax in the Birt-Hogg-Dubé syndrome. Cancer Epidemiol Biomarkers Prev 2002;11:393–400.
11. Hartman TR, Nicolas E, Klein-Szanto A, Al-Saleem T, Cash TP, Simon MC, et al. The role of the Birt-Hogg-Dube protein in mTOR activation and renal tumorigenesis. Oncogene 2009;28:1594–1604.
12. Lopez V, Jorda E, Monteagudo C. Birt-Hogg-Dubé syndrome: an update. Actas Dermosifiliogr 2012;103:198–206.
13. Vincent A, Farley M, Chan E, James WD. Birt-Hogg-Dubé syndrome: a review of the literature and the differential diagnosis of firm facial papules. J Am Acad Dermatol 2003;49:698–705.
14. Tobino K, Hirai T, Johkoh T, Kurihara M, Fujimoto K, Tomiyama N, et al. Differentiation between Birt-Hogg-Dubé syndrome and lymphangioleiomyomatosis: quantitative analysis of pulmonary cysts on computed tomography of the chest in 66 females. Eur J Radiol 2012;81:1340–1346.
15. Butnor KJ, Guinee DG Jr. Pleuropulmonary pathology of Birt-Hogg-Dubé syndrome. Am J Surg Pathol 2006;30:395–399.
16. Toro JR, Pautler SE, Stewart L, Glenn GM, Weinreich M, Toure O, et al. Lung cysts, spontaneous pneumothorax, and genetic associations in 89 families with Birt-Hogg-Dubé syndrome. Am J Respir Crit Care Med 2007;175:1044–1053.
17. Gupta N, Seyama K, McCormack FX. Pulmonary manifestations of Birt-Hogg-Dubé syndrome. Fam Cancer 2013;12:387–396.
18. Cho MH, Klanderman BJ, Litonjua AA, Sparrow D, Silverman EK, Raby BA. Folliculin mutations are not associated with severe COPD. BMC Med Genet 2008;9:120.
19. Furuya M, Nakatani Y. Birt-Hogg-Dube syndrome: clinicopathological features of the lung. J Clin Pathol 2013;66:178–186.