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Abid W, Ladeb MF, Chidambaranathan N, Peh WCG, Vanhoenacker FM. Imaging of musculoskeletal tuberculosis. Skeletal Radiol 2024; 53:2081-2097. [PMID: 38231262 DOI: 10.1007/s00256-023-04556-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
Tuberculosis (TB) represents a major public health problem worldwide. Any tissue may be infected. Involvement of the musculoskeletal (MSK) system account for 1-3% of all tuberculous infections. MSK TB may manifest as tuberculous spondylitis, arthritis, osteomyelitis, and soft tissue infections. Although TB spondylitis may present with distinctive imaging features compared to pyogenic infections of the spine, the imaging semiology of extra-spinal TB infections is mostly nonspecific and may mimic other lesions. TB infections should therefore always be considered in the differential diagnosis, particularly in immunocompromised patients. The aim of this article is to review the imaging features of spinal and extra-spinal MSK TB. Magnetic resonance imaging is considered the modality of choice to make the diagnosis and to evaluate the extent of the disease.
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Affiliation(s)
- Wiem Abid
- Department of Radiology, (Vrije Universiteit Brussel), University Hospital Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Mohamed F Ladeb
- Department of Radiology, MT Kassab Institute of Orthopaedics, Tunis, Tunisia
| | - Natesan Chidambaranathan
- Department of Radiology & Imaging Sciences, Apollo Hospitals, 21, Greams Lane, Chennai, 600 006, India
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Republic of Singapore
| | - Filip M Vanhoenacker
- General Hospital Sint-Maarten Mechelen, Liersesteenweg 435, 2800, Mechelen, Belgium.
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat, 655, B-2650, Edegem, Belgium.
- Faculty of Medicine and Health Sciences, University of Antwerp, Ghent and KU Leuven, Belgium.
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Leong VJ, Abbas AA, Ayob KA, Loh KW, Rahman NA, Selvaratnam V. Rice Body Formation in an Enterococcus faecalis-Infected Total Hip Arthroplasty Causing Sciatic Nerve Compression. Cureus 2024; 16:e67798. [PMID: 39323682 PMCID: PMC11423393 DOI: 10.7759/cureus.67798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2024] [Indexed: 09/27/2024] Open
Abstract
We present a case of a 73-year-old lady with a previous uncemented left total hip arthroplasty (THA) three years prior to her current presentation. She presented with an enlarging 'granulomatous'-looking swelling at the distal aspect of her THA scar for three months that was associated with shooting pain from the posterior aspect of her hip radiating down to her foot. The culture and sensitivity of her hip aspirate revealed the growth of Enterococcus faecalis. She underwent revision surgery utilising a 'well-fixed' Exeter custom-made articulating spacer (CUMARS). Intra-operatively, a large encapsulated cyst containing rice bodies was discovered deep within the fascia lata. A complete excision of this cyst was performed. Post-operatively, the patient was treated with two weeks of IV antibiotics and ten weeks of oral antibiotics. Histopathological examination confirmed the presence of rice bodies, with no malignancy seen. We aim to highlight the possibility of rice body cyst formation in the setting of a periprosthetic joint infection (PJI) around a THA and the importance of early treatment in such cases. This is the first published report of a rice body cyst formation in an infected THA.
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Affiliation(s)
- Van Jet Leong
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL) Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Azlina A Abbas
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL) Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Khairul A Ayob
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL) Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Kwong Weng Loh
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL) Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Nazarina A Rahman
- Department of Pathology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Veenesh Selvaratnam
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL) Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
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Xie T, Cheng T, Zhang Y, Ma Z, Li M, Liu Y. Case report: Systemic lupus erythematosus combined with rice body formation. Int J Rheum Dis 2024; 27:e15152. [PMID: 38664877 DOI: 10.1111/1756-185x.15152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/06/2024] [Accepted: 04/02/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Tianhua Xie
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine (2023 doctoral student), Jinan, China
- Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University (Shandong Provincial Hospital), Jinan, China
| | - Tianqing Cheng
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University (Shandong Provincial Hospital), Jinan, China
| | - Yijing Zhang
- Department of Geriatric Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University (Shandong Provincial Hospital), Jinan, China
| | - Zhenzhen Ma
- Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University (Shandong Provincial Hospital), Jinan, China
| | - Ming Li
- Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University (Shandong Provincial Hospital), Jinan, China
| | - Ying Liu
- Department of Rheumatology and Immunology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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Qi W, Ren Y, Wang H, Wan Y, Pan H, Yao J. Candida parapsilosis-Caused Arthritis with Rice Body Formation: A Case Presentation and Literature Review. Infect Drug Resist 2023; 16:4123-4135. [PMID: 37396064 PMCID: PMC10312336 DOI: 10.2147/idr.s416990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023] Open
Abstract
A 68-year-old male patient came to the orthopedics department because of swelling and pain in his left shoulder joint. He received more than 15 intraarticular steroid injections in the shoulder joint at a local private hospital. MRI showed that the synovial membrane of the joint capsule was thickened and swollen, and there were extensive "rice body-like" low T2 signal shadows filling. Arthroscopic removal of rice bodies and subtotal bursectomy were performed. The observation channel was placed through the posterior approach, and a large amount of rice bodies in yellow bursa fluid were observed to flow out. Rice bodies with a diameter of approximately 1-5 mm filled the joint cavity were seen in the observation channel. The histopathological examination of the rice body showed that it was mainly composed of fibrin without a clear tissue structure. Bacterial and fungal cultures of synovial fluid suggested Candida parapsilosis infection, so the patient received antifungal treatment. However, the shoulder swelled again after three weeks, MRI revealed that there was significant fluid accumulation in the subacromial-subdeltoid region with necrotic synovial tissue floating and ultrasound examination showed joint cavity effusion, synovial hyperplasia, and some synovium looked like "floating weeds". After 2 weeks, there were recurrent rice bodies in the articular cavity. Arthroscopic surgery was performed again to clean the joint and a catheter was placed for irrigation and drainage, and a large amount of necrotic synovial tissue floating as seen in ultrasound. Finally, patient received sensitive antifungal treatment and did not relapse within 6 months. During the recurrence in the current case, we recorded the process of rice body formation, which has for the first time been reported.
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Affiliation(s)
- Weihui Qi
- Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Department of Orthopaedics, Hangzhou Ding Qiao Hospital, Hangzhou, People’s Republic of China
| | - Yanyun Ren
- Department of Stomatology No. 903 Hospital of PLA, Hangzhou, People’s Republic of China
| | - Huang Wang
- Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Department of Orthopaedics, Hangzhou Ding Qiao Hospital, Hangzhou, People’s Republic of China
| | - Yue Wan
- Department of Stomatology No. 903 Hospital of PLA, Hangzhou, People’s Republic of China
| | - Hao Pan
- Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Department of Orthopaedics, Hangzhou Ding Qiao Hospital, Hangzhou, People’s Republic of China
| | - Jun Yao
- Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Department of Orthopaedics, Hangzhou Ding Qiao Hospital, Hangzhou, People’s Republic of China
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Kim DH, Lee JH, Jeong MJ, Kim SH, Kim JY, Kim SH, Kang MJ. [Rice Bodies Presenting as Intra-Articular Masses in Pediatric Idiopathic Arthritis: A Case Report]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:731-735. [PMID: 37324987 PMCID: PMC10265230 DOI: 10.3348/jksr.2022.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/12/2022] [Accepted: 10/31/2022] [Indexed: 06/17/2023]
Abstract
Rice bodies are commonly detected in adults with rheumatoid arthritis and rarely occur in children. An 11-year-old female adolescent who visited our hospital for evaluation of knee pain underwent a MRI scan, which revealed an intra-articular mass. Arthroscopic examination of the mass confirmed conglomerated rice bodies. We report a case of rice bodies that clinically presented as intra-articular masses.
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Tian Y, Zhou HB, Yi K, Wang KJ. Idiopathic tenosynovitis of the wrist with multiple rice bodies: A case report and review of literature. World J Clin Cases 2022; 10:11908-11920. [PMID: 36405290 PMCID: PMC9669876 DOI: 10.12998/wjcc.v10.i32.11908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/19/2022] [Accepted: 10/19/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Multiple rice bodies in the wrist is a rare disorder that requires surgery, and there are still many uncertainties regarding its diagnosis and treatment.
CASE SUMMARY We described a rare case of chronic idiopathic tenosynovitis with rice bodies of the wrist in a 71-year-old man and reviewed similar topics in the literature. A total of 43 articles and 61 cases were included in the literature review. Our case had a usual presentation: it was similar to those in the literature. The affected population was mainly older adults, with an average age of 59.43 (range, 3 to 90) years. The male-to-female ratio was 1.54:1 (37/24).Most of them showed limited swelling and pain, only 23.0% had carpal tunnel symptoms, and the average disease duration was 18.03 (0.5-60) mo. Wrist flexor tendon sheath involvement was the most common (95.1%, 58/61), and only 3 cases had extensor tendon sheath involvement.The main causes were tuberculosis (34.4%, 21/61), non-tuberculous mycobacteria (24.6%, 15/61), idiopathic tenosynovitis (31.1%, 19/61), and others (9.84%, 6/61). There were 10 patients with recurrences; in 6 of them, were due to non-tuberculous mycobacterial infections.
CONCLUSION We reported a case of wrist idiopathic tenosynovitis with rice body formation, and established a clinical management algorithm for wrist tenosynovitis with rice bodies, which can provide some reference for our clinical diagnosis and treatment. The symptoms of rice-body bursitis of the wrist are insidious, nonspecific, and difficult to identify. The aetiology is mainly idiopathic tenosynovitis and mycobacterial (tuberculosis or non-tuberculous) infections; the latter are difficult to treat and require long-duration systemic combination antibiotic therapies. Therefore, before a diagnosis of idiopathic tenosynovitis is made, we must exclude other causes, especially mycobacterial infections.
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Affiliation(s)
- Yong Tian
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| | - Hong-Bin Zhou
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| | - Kai Yi
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| | - Kai-Jian Wang
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
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Ghandour M, Dagher T, Tannous A, Zeaiter N, Salem S. Rice Bodies Accompanied by Tenosynovitis of the Wrist: A Case Report and Literature Review. Cureus 2022; 14:e29682. [DOI: 10.7759/cureus.29682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
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Sener S, Tanali G, Ergen FB, Kasap Cuceoglu M, Balik Z, Bayindir Y, Aliyev E, Basaran O, Bilginer Y, Ozen S, Batu ED. Rice Bodies in Children with Rheumatic Disorders: A Case Series and Systematic Literature Review. Mod Rheumatol 2022:6640188. [PMID: 35819010 DOI: 10.1093/mr/roac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/13/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Rice body (RB) formation is an uncommon inflammatory process seen in systemic disorders. In this study, we aimed to assess characteristic features of RBs in pediatric patients. METHOD We retrospectively evaluated pediatric patients who underwent joint/extremity magnetic resonance imaging (MRI). A systematic literature review was conducted for articles including children with RBs. RESULTS We found 24 patients (median age 6.1 years; F/M=2.4) with RBs [23 with juvenile idiopathic arthritis (JIA) and one with arthralgia]. The most prevalent location for RBs was the knee joint (75%). RBs were most frequently seen as diffuse multiple millimetric structures. In three out of five patients with follow-up MRI, resolution or regression of RBs was observed without surgical intervention. Our literature search identified 13 pediatric patients with RBs. Most (84.6%) had JIA, and the knee joint (71.4%) was the most commonly affected joint. Surgery was preferred in our three patients (12.5%) and ten literature patients (83.3%) in the treatment. CONCLUSION Our results showed that RBs were most commonly detected in the knee joint, and most cases were secondary to JIA. Although surgery is used as a treatment option, we observed that RBs can occasionally disappear during follow-up without surgical intervention.
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Affiliation(s)
- Seher Sener
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gizem Tanali
- Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fatma Bilge Ergen
- Division of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Muserref Kasap Cuceoglu
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Balik
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yagmur Bayindir
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Emil Aliyev
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ozge Basaran
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Ozen
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Haibo Z, Tianrui W, Wenlian S, Shenjie S, Chunpu L, Xia Z, Tengbo Y, Yingze Z. A Case of Rice Body Synovitis of the Knee Joint. Orthop Surg 2022; 14:628-632. [PMID: 35297195 PMCID: PMC8926980 DOI: 10.1111/os.13195] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Rice body synovitis (RBS) is a rare disease. It is prone to be developed due to rheumatoid disorder or tuberculosis infection. Additional infectious arthritis (non‐tuberculous mycobacterial infection and fungal infection), juvenile arthritis, the onset of adult Still's disease, systemic lupus erythematosus (SLE), seronegative arthritis, and non‐specific arthritis. The clinical imaging, histopathological features, and surgical treatment process of a patient were documented combined with literature. Furthermore, differentiation was performed with additional synovitis diseases so that the cognition of synovitis could be enhanced for clinical reference. Case Presentation The present study reported a 50‐year‐old female patient who suffered from intermittent left knee pain with limited movement for 9 years. The conditions were aggravated after long‐term standing or walking and remitted after taking a rest, accompanied by noose and jamming. The specialist range of motion (ROM) examinations of the left knee revealed: 30° ‐ 0° ‐ 110° and left McMurray sign (+). Plain MRI scanning revealed that in the left knee cavity and the popliteal fossa area, a large number of low signals on free rice‐like bodies were visible inside and the lower femur and the upper tibia exhibited abnormally high signals of patchy lipography. Surgical exploration revealed numerous rice‐like free bodies in the suprapatellar bursa, the intercondylar fossa, and the posterior articular capsule. The patient presently has resolution of symptoms after surgical treatment. Conclusions The RBS of the knee joint is very rare in the clinic. As MRI examination can provide valuable information, clinicians should actively perform MRI examination. Once the disease is diagnosed by examination, surgery is the optimal treatment.
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Affiliation(s)
| | - Wang Tianrui
- Orthopedics Department of the Affiliated Hospital of Qingdao University, Qingdao, China
| | | | | | | | - Zhao Xia
- Orthopedics Department of the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yu Tengbo
- Orthopedics Department of the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhang Yingze
- Trauma Emergency Center of the Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
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Fice M, Patel V, Solarewicz J, Gusho C, Miller I, Blank A. Subdeltoid Rice Bodies in a Patient with Rheumatoid Arthritis on Disease Modifying Antirheumatic Drug Therapy: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00118. [PMID: 34115659 DOI: 10.2106/jbjs.cc.20.00879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 58-year-old man with rheumatoid arthritis (RA) on disease modifying antirheumatic drug therapy presented with chronic right shoulder pain. Magnetic resonance imaging was concerning for rice body disease which was confirmed through histology after intraoperative deltoid bursa resection. CONCLUSIONS Rice bodies can develop regardless of RA symptom severity or the degree of RA medical therapy administered. Therefore, physicians should not disregard rice bodies as a possible cause of symptoms in individuals on appropriate RA medical therapy or who are demonstrating adequate RA symptom and flair control.
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Affiliation(s)
- Michael Fice
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Vishal Patel
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Joanna Solarewicz
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Charles Gusho
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Ira Miller
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Alan Blank
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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Kitagawa A, Nakamura T, Hashimoto Y. Infectious Rice Body Formation in a Patient with Anti-aminoacyl-t RNA Synthetase Syndrome: A Case Report. JBJS Case Connect 2020; 10:e20.00205. [PMID: 33512928 DOI: 10.2106/jbjs.cc.20.00205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE An adult woman with anti-aminoacyl-t RNA synthetase syndrome developed pain and swelling of both hands and her left forearm, initially diagnosed as seronegative rheumatoid arthritis. Surgical exploration revealed multiple "rice bodies," and the specimen grew Mycobacterium intracellurale. She subsequently received antibiotic therapy. CONCLUSION In the diagnosis of rice body formation in musculoskeletal tissues, it is necessary to consider not only rheumatic diseases but also mycobacterial infection.
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Affiliation(s)
- Atsushi Kitagawa
- Department of Orthopaedic Surgery, Hyogo Rehabilitation Center Hospital, Hyogo, Japan.,Department of Rheumatoligy, Hyogo Rehabilitation Center Hospital, Hyogo, Japan
| | - Tomoko Nakamura
- Department of Rheumatoligy, Hyogo Rehabilitation Center Hospital, Hyogo, Japan
| | - Yasushi Hashimoto
- Department of Orthopaedic Surgery, Hyogo Rehabilitation Center Hospital, Hyogo, Japan
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13
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Guo JJ, Wu K, Xu Y, Yang H. Hundreds of rice bodies in the subacromial-subdeltoid bursa: report of two cases and literature review. BMC Musculoskelet Disord 2020; 21:539. [PMID: 32787818 PMCID: PMC7424980 DOI: 10.1186/s12891-020-03563-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 08/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background Multiple rice bodies (RB) in the shoulder joint is a rare disorder of unknown etiology that requires percutaneous drainage or surgical operation. Case presentation We reported arthroscopic removal of hundreds of RB in the subacromial-subdeltoid bursa in two cases by our “chopsticks technique”. One was associated with seropositive rheumatoid arthritis and the other was a rare synovial origin possibly due to microinfarction and ischemia after the radiotherapy. Radical debridement of necrotic tissue, “red tissue” and synovitis by arthroscopic radiofrequency ablation was essential for eliminating the cause of RB. A favorable clinical evolution was observed for both patients. Conclusions We highlight the importance of patient-specific differential diagnosis and the clinical course of RB to help us further understand the pathogenesis of this uncommon disorder. Meanwhile, evacuation of RB and “red tissue” ablation by arthroscopy showed good results.
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Affiliation(s)
- Jiong Jiong Guo
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, 215006, China.
| | - Kailun Wu
- Department of Orthopedics, Suzhou Dushuhu Public Hospital (The Affiliated Dushuhu Hospital of Soochow University), Suzhou, China
| | - Yingjie Xu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, 215006, China.,Department of Orthopedics, Suzhou Dushuhu Public Hospital (The Affiliated Dushuhu Hospital of Soochow University), Suzhou, China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, 215006, China
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Persons B, Kissin EY. Scruples over Speckles. J Med Ultrasound 2020; 28:179-180. [PMID: 33282663 PMCID: PMC7709533 DOI: 10.4103/jmu.jmu_122_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 11/25/2022] Open
Abstract
The “snowstorm” sign refers to the ultrasound appearance of motile hyperechoic specks within synovial fluid and has been reported to have a high specificity for gout. We describe three additional etiologies commonly encountered in the rheumatology clinic that can produce a snowstorm: calcium pyrophosphate deposition disease, fibrin collections/rice bodies, and gas bubbles in viscous synovial fluid.
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Affiliation(s)
- Benjamin Persons
- Division of Rheumatology, Boston University Medical Center, Boston, MA, USA
| | - Eugene Y Kissin
- Division of Rheumatology, Boston University Medical Center, Boston, MA, USA
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Tabrizi A, Mohammadi S, Ghasemi-Rad M, Dindarian S. Unusual presentation of rice body formation in a patient without tuberculosis or rheumatic disease: report of a rare case and literature review. CURRENT ORTHOPAEDIC PRACTICE 2020; 31:305-310. [DOI: 10.1097/bco.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ali Tabrizi
- Assistant professor, Department of Orthopedics, Urmia University of Medical Sciences, Urmia, Iran
| | - Sedra Mohammadi
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Sina Dindarian
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
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Perţea M, Veliceasa B, Velenciuc N, Terinte C, Mitrea M, Ciobanu P, Alexa O, Luncă S. Idiopathic tenosynovitis with rice bodies. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2020; 61:457-463. [PMID: 33544797 PMCID: PMC7864287 DOI: 10.47162/rjme.61.2.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 12/12/2020] [Indexed: 11/10/2022]
Abstract
PURPOSE Idiopathic tenosynovitis with rice bodies is a rare disease and its non-association with rheumatic diseases, tuberculosis infection or trauma is reported only in few cases in literature. PATIENTS, MATERIALS AND METHODS Our study presents a series of five patients diagnosed with tenosynovitis with rice bodies at the flexor tendons of the upper limb. Medical history revealed no associated disease or trauma. Disease duration ranged between two months and four years, two patients presenting symptoms of acute carpal tunnel and three patients tumor mass. In one case, the tumor measured 210 mm in length and a tendon rupture was suspected. Laboratory and imaging investigations could not establish a specific associated pathology and a preoperative diagnosis. Surgical treatment consisting of synovectomy was performed in all patients. RESULTS In all five cases, intraoperative appearance could easily determine the presence of rice bodies. Histopathological examination revealed typical aspect for rice bodies and make the diagnosis possible without the need for other more laborious processing (immunohistochemistry). The amount of rice bodies was directly proportional to disease duration. In all cases, the recovery was complete. After a median 30.4-month follow-up, no recurrence was detected. Subsequently performed laboratory investigations and specific tests did not reveal tuberculosis infection, rheumatic disease, or other diseases. CONCLUSIONS This is the largest series of patients with idiopathic tenosynovitis with rice bodies and the bigger tumor mass reported to date. Synovectomy with removal of all rice bodies represents the optimal treatment. A longer disease course may be associated with a larger number of rice bodies, which may be associated with tendon rupture. The etiopathogenesis remains unclear, further studies being necessary to establish it.
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Affiliation(s)
- Mihaela Perţea
- Department of Plastic Surgery and Reconstructive Microsurgery, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Bogdan Veliceasa
- Department of Orthopedics and Traumatology, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Natalia Velenciuc
- Department of Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Cristina Terinte
- Department of Pathology, Regional Institute of Oncology, Iaşi, Romania
| | - Mihaela Mitrea
- Department of Morphofunctional Sciences I, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Petru Ciobanu
- Department of Plastic Surgery and Reconstructive Microsurgery, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Ovidiu Alexa
- Department of Orthopedics and Traumatology, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Sorinel Luncă
- Department of Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
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Matta Ramos RF, Cancian L, Calcagnotto F, Zeni R, Varela G, Burgues T, Silva JB. Synovial tuberculosis of the hand: An ancient disease in an unusual localisation. Indian J Plast Surg 2019; 50:130-137. [PMID: 29343887 PMCID: PMC5770925 DOI: 10.4103/ijps.ijps_73_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Tuberculosis is the most prevalent infectious disease in the world. It is mainly caused by Mycobacterium tuberculosis. Osteoarticular tuberculosis represents 1%-3%. Tenosynovitis is the most common form of the disease in the hand. Aims The aim of this study is to present an update of synovial tuberculosis. Materials and Methods The authors present a literature review, the clinical and surgical management and case reports. Results The outcomes were satisfactory and were not report complications. Conclusions Early diagnosis, surgical transection of the transverse carpal ligament, debridement and complete excision of the infected synovium may be required, along with antituberculosis drugs. Knowledge of this disease in the hand can provide a better diagnosis and outcome.
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Affiliation(s)
| | - Lucas Cancian
- Hand and Reconstructive Microsurgery Department and School of Medicine, Saint Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernando Calcagnotto
- Hand and Reconstructive Microsurgery Department and School of Medicine, Saint Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ricardo Zeni
- Hand and Reconstructive Microsurgery Department and School of Medicine, Saint Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriel Varela
- Hand and Reconstructive Microsurgery Department and School of Medicine, Saint Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Tamsin Burgues
- General Surgery Department, Santa Casa da Misericordia Hospital, Rio de Janeiro, Brazil
| | - Jefferson Braga Silva
- Hand and Reconstructive Microsurgery Department and School of Medicine, Saint Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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Yamamoto D, Tada K, Suganuma S, Ikeda K, Tsuchiya H. Non-tuberculous Mycobacterium or Fungus Induced Chronic Tenosynovitis with Rice Body of the Hand. J Hand Surg Asian Pac Vol 2019; 22:337-342. [PMID: 28774249 DOI: 10.1142/s0218810417500393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chronic tenosynovitis of the wrist and hand is commonly seen by orthopedists, especially hand surgeons. However, cases with rice body formation are comparatively rare. Thus, we retrospectively reviewed the cases of chronic tenosynovitis in our department and evaluated the necessity of antibiotic therapy in the early post-surgical stage. METHODS We analyzed the medical and surgical records of patients who had undergone surgery for chronic tenosynovitis with rice body formation in our department from 1997 to 2015. We evaluated the causes of chronic tenosynovitis, culture findings, pathological findings, and post-operative treatment courses. RESULTS Nineteen patients with 23 involved hands underwent surgery for chronic tenosynovitis, and 9 patients had rice body formation. The most common cause of chronic tenosynovitis was non-tuberculous mycobacteriosis, and other causes were fungal infection and infection of unknown origin. Recurrence was observed in 2 cases of mycobacteriosis and 1 case of fungal infection; 1 case of mycobacteriosis also had a re-recurrence. CONCLUSIONS In the diagnosis of chronic tenosynovitis with rice body formation, it is necessary to consider not only non-tuberculous mycobacteriosis, but also fungal infection as its origin. However, it is difficult to define the cause of synovitis, but in cases in which these infections are suspected, anti-bacterial therapy in the early post-surgical period could be effective.
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Affiliation(s)
- Daiki Yamamoto
- 1 Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan
| | - Kaoru Tada
- 1 Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan
| | - Seigo Suganuma
- 1 Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan
| | - Kazuo Ikeda
- 1 Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- 1 Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan
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Gupta L, Gupta V, Kumar T. Rice Bodies in Tuberculous Tenosynovitis of Wrist. REUMATOLOGIA CLINICA 2018; 14:314-316. [PMID: 29102590 DOI: 10.1016/j.reuma.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 08/20/2017] [Accepted: 08/25/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Latika Gupta
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Vikas Gupta
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India.
| | - Tushant Kumar
- Department of Radiodiagnosis, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow 226010, Uttar Pradesh, India
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Campos LR, das Neves Sztajnbok FC, Galvão S, de Araújo Lessa M, Aymoré IL, Sztajnbok F. Presence of riziform bodies in a patient with juvenile idiopathic arthritis: case report and literature review. REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57:610-612. [PMID: 29173696 DOI: 10.1016/j.rbre.2014.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 09/14/2014] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Stélio Galvão
- Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Rio de Janeiro, RJ, Brazil
| | - Marise de Araújo Lessa
- Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Rio de Janeiro, RJ, Brazil
| | - Ierecê Lins Aymoré
- Hospital Mário Kroeff, Laboratório Cláudio Lemos Anatomia Patológica Ltda., Rio de Janeiro, RJ, Brazil
| | - Flavio Sztajnbok
- Universidade do Estado do Rio de Janeiro, Núcleo de Estudos da Saúde do Adolescente, Rio de Janeiro, RJ, Brazil.
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A Large Rice Body-Containing Cyst Mimicking Infection following Total Hip Arthroplasty: A Case Report. Case Rep Orthop 2017; 2017:5354298. [PMID: 28656116 PMCID: PMC5474539 DOI: 10.1155/2017/5354298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/03/2017] [Accepted: 05/07/2017] [Indexed: 12/17/2022] Open
Abstract
Introduction Soft tissue mass following total hip arthroplasty raises several differential diagnoses not limited to infection, hematoma, wear debris, malignancy, and bursitis. Rice body formation in the hip region is an uncommon process denoting a chronic inflammation. We report here the second case of its kind in the medical literature of a wide symptomatic rice-like body cyst complicating a total hip arthroplasty. Case Presentation This is the case of an 82-year-old white female, presenting with a warm, red, and inflated groin five years after revision of right total hip arthroplasty. Surgical intervention reveals a large well circumscribed cyst containing well-organized rice-like bodies. This eventuality was never reported in differential diagnosis of hip periprosthetic soft tissue masses before. Conclusion This case report helps widening the array of the differential diagnosis in patients presenting with a slow growing soft tissue mass following total hip arthroplasty, making rice-like bodies cyst a valid one to consider.
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Abstract
Most commonly associated with chronic inflammatory conditions, rice bodies represent an uncommon, nonspecific, often intra-articular inflammatory process. Presumably, rice bodies represent the sequelae of microvascular infarcts of the joint synovium. However, rice bodies have been seen in pleural fluid, in the setting of bursitis, and within the tendon sheath. The etiology and prognostic significance of rice bodies are not clear. MRI is the diagnostic imaging modality of choice for the evaluation of rice body formation. Here we present a case of a 28-year-old female with a history of rheumatoid arthritis (RA) who presented to her primary care physician with a palpable mass around her right shoulder which was presumed to be a lipoma. An initial ultrasound showed a fluid filled structure with internal debris. Subsequent MRI evaluation was confirmatory for subacromial-subdeltoid bursitis with rice body formation. The salient point of this report is to highlight the importance of patient-specific differential diagnosis. While lipomas are a very common benign soft tissue tumor, patients with RA often have disease-specific sequelae that should be included in the diagnostic deliberation. Thus, when ordering diagnostic testing for patients with a palpable mass and rheumatoid arthritis, MRI--possibly preceded by conventional radiography--is the most appropriate diagnostic algorithm.
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Chung WY, Song JS, Oh HE, Park HJ. A Case of Idiopathic Massive Rice Bodies in the Knee Joint without Rheumatoid Arthritis or Tuberculosis and a Literature Review. JOURNAL OF RHEUMATIC DISEASES 2016. [DOI: 10.4078/jrd.2016.23.5.316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Whan Yong Chung
- Department of Orthopedics, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea
| | - Ji-Sun Song
- Department of Pathology, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea
| | - Hwa Eun Oh
- Department of Pathology, Korea University Ansan Hospital, Ansan, Korea
| | - Hee Jin Park
- Department of Rheumatology, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea
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Rice Body Tenosynovitis without Tuberculosis Infection after Multiple Acupuncture Procedures in a Hand. Arch Plast Surg 2015. [PMID: 26217578 PMCID: PMC4513066 DOI: 10.5999/aps.2015.42.4.502] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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25
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Campos LR, Sztajnbok FCDN, Galvão S, Lessa MDA, Aymoré IL, Sztajnbok F. [Presence of riziform bodies in a patient with juvenile idiopathic arthritis: case report and literature review.]. REVISTA BRASILEIRA DE REUMATOLOGIA 2014; 57:S0482-5004(14)00192-2. [PMID: 25467403 DOI: 10.1016/j.rbr.2014.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 09/01/2014] [Accepted: 09/14/2014] [Indexed: 11/24/2022] Open
Abstract
Riziform bodies are structures formed by fibrin and cells that can be found in the synovial fluid or attached to the synovium, and have this denomination due to its rice grain-like appearance. They have already been described in several diseases such as tuberculous arthritis, rheumatoid arthritis, and rarely in juvenile idiopathic arthritis (JIA). This is the case of a boy with a 4-month course of chronic monoarthritis of the left knee, with family history of sarcoidosis in which diagnostic investigation showed the presence of these riziform bodies in the synovial biopsy. Diagnostic investigation ruled out sarcoidosis, tuberculosis and malignancies, establishing the diagnosis of JIA. Our objective was to describe what we believe is the 9th case reported on the presence of riziform bodies in JIA, which are probably underdiagnosed, and should be considered mainly in cases of severe arthritis of difficult medical treatment.
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Affiliation(s)
| | | | - Stélio Galvão
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Marise de Araújo Lessa
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Ierecê Lins Aymoré
- Laboratório Cláudio Lemos Anatomia Patológica Ltda. Hospital Mário Kroeff, Rio de Janeiro, RJ, Brasil
| | - Flavio Sztajnbok
- Universidade Federal do Rio de Janeiro, Núcleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
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