Birt-Hogg-Dubé symptoms in Smith-Magenis syndrome

Smith-Magenis Syndrome (SMS) is a neurodevelopmental condition most commonly caused by a deletion of an area called 17p11.2 on chromosome 17. The gene which predominantly causes the neurodevelopmental symptoms exhibited in SMS is called Retinoic Acid Induced 1 (RAI1), however in most cases of SMS multiple genes on this region of chromosome 17 are affected including Folliculin (FLCN). Variants in Folliculin including deletions cause Birt-Hogg-Dubé syndrome (BHD). Interestingly there have been very few reports of BHD symptoms occurring in SMS. A recent study by Finucane et al., collected data from 117 SMS patients asking if they had any of the three core symptoms associated with BHD: fibrofolliculomas, pneumothorax and kidney cancer. Five people reported pneumothoraces and two reported fibrofolliculoma. Four of the pneumothoraces occurred in childhood, three being under the age of 4. This differs to individuals with BHD syndrome, who most commonly develop their first spontaneous pneumothoraces in their 20’s or 30’s.  It must be noted that unexpectedly one of the participants who developed a pneumothorax only had a mutation in their RAI1 gene and not Folliculin . It remains to be determined if this was an unrelated spontaneous event or if there is a relationship between RAI1 and Folliculin.

Although more research is required to fully understand the relationship between BHD and SMS, this study suggests that patients with SMS may be at greater risk of manifesting symptoms of BHD and it is important for families to be aware of the association so that they can recognize symptoms of BHD early. 

PRISM is a nonprofit, advocacy, education, and support organization for individuals with SMS and their families. They provide advice on their website regarding BHD and recommendations for kidney screening.  


Finucane B, Savatt JM, Shimelis H, Girirajan S, Myers SM. Birt-Hogg-Dubé symptoms in Smith-Magenis syndrome include pediatric-onset pneumothorax. Am J Med Genet A 2021. doi: 10.1002/ajmg.a.62159.

2 thoughts on “Birt-Hogg-Dubé symptoms in Smith-Magenis syndrome

  1. So, most SMS patients have a deletion that includes the whole of FLCN, yet few have been reported with spontaneous pneumos. This just does not compute [unless other issues are so overwhelming that pneumos are ignored in published accounts, which is imaginable but does not seem like good practice].

    Does the article (which is behind a paywall) discuss how many have lung cysts consistent with BHD, despite no spontaneous pneumo?

  2. Thank you for your comment Richard. Firstly it is unexpected that there have been so few accounts of pneumothorax in SMS and the neurodevelopmental symptoms of SMS is unlikely to mask a pneumothorax. It must be noted that multiple other genes are affected in SMS in addition to folliculin. The relationship between SMS and BHD is still not fully understood and so further studies for example looking at imaging and larger patient groups is needed.

    One of the limitations of the article is that the symptoms were self reported so no imaging was looked at.

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