Chronic peritoneal inflammation and nodules masquerading as peritoneal carcinomatosis in Birt–Hogg–Dube syndrome

Abstract

A 50-year-old male presented after a computed tomography (CT) scan performed for epigastric pain and bloating showed bilateral renal tumours and peritoneal thickening. There was no weight loss or change in bowel habit. His past medical history included psoriasis and appendicectomy 3 years prior. Physical examination revealed psoriatic plaques and nodular lesions on his face (Fig. 1). With the presence of bilateral renal lesions and skin lesions the possibility of Birt–Hogg–Dube (BHD) syndrome was raised. The CT scan showed bilateral renal tumours with two enhancing, left interpolar renal lesions, measuring 32 and 31 mm in diameter, suspicious for renal cell carcinoma (RCC) (Fig. 2). The right kidney showed several renal cysts and a 7 mm inferior pole lesion. The peritoneum was abnormal with diffuse thickening and peritoneal nodules consistent with peritoneal carcinomatosis. The sigmoid colon was mildly thickened. A bone scan and staging CT showed no further evidence of metastatic disease. Tumour markers