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Wang L, Jin Y, Huang H, Yang Z, Ding F, Xu X, Liu C, Bao S, Han X, Ma J, Jin Y, Cai H. Rice body synovitis in pediatrics: three different case reports. Front Pediatr 2024; 12:1391229. [PMID: 38938505 PMCID: PMC11210276 DOI: 10.3389/fped.2024.1391229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/13/2024] [Indexed: 06/29/2024] Open
Abstract
Rice body synovitis (RBS) is a rare disease, especially in children. Rheumatoid disorders and tuberculosis are the first two reasons for the formation of the RB. The diagnosis is mainly based on imaging and histopathological features. Herein, we report three cases of RBS in children diagnosed with congenital synovial chondromatosis, tuberculosis (unconfirmed), and ANA -positive juvenile idiopathic arthritis. Clinical features, radiographic findings, pathophysiology, treatment process, and prognosis were reviewed and documented meticulously to enhance cognition in this population and provide some references for clinicians in diagnosing and treating the disease.
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Affiliation(s)
- Liping Wang
- Department of Rheumatology and Immunology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yingying Jin
- Department of Rheumatology and Immunology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hua Huang
- Department of Rheumatology and Immunology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhen Yang
- Department of Rheumatology and Immunology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fei Ding
- Department of Rheumatology and Immunology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xuemei Xu
- Department of Rheumatology and Immunology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chenxi Liu
- Department of Rheumatology and Immunology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shengfang Bao
- Department of Rheumatology and Immunology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiqiong Han
- Department of Rheumatology and Immunology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Ma
- Department of Pathology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yanliang Jin
- Department of Rheumatology and Immunology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haiqing Cai
- Department of Orthopedic, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 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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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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Gillijns M, Vandesande W. Rice bodies in the wrist. Mod Rheumatol Case Rep 2022; 6:150-154. [PMID: 34614514 DOI: 10.1093/mrcr/rxab040] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/20/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
Rice bodies are a rare finding in medicine and offer a therapeutic challenge. As their occurrence varies over multiple rheumatic as well as infectious diseases, multiple hypotheses have been made about their origin. While rice bodies are most frequently reported in the shoulder and knee joints, flexor tendon synovitis with accompanying rice bodies is rarer. We report a case of extensive flexor tenosynovitis with rice bodies in the wrist in a 90-year-old patient with seronegative rheumatoid arthritis. The patient reported a 5-month history of painful swelling of the right wrist. Ultrasound showed pronounced swelling of the synovial tissue of the flexor tendons. Laboratory test were negative for rheumatology tests with normal C-reactive protein and sedimentation rates. T2-weighted magnetic resonance imaging demonstrated an extensive synovitis reaching from the distal forearm into the hand with inclusions, better known as rice bodies. Synovectomy including carpal tunnel release was performed with dissection of the mass revealing an extensive synovitis with a multitude of rice bodies. Histopathology showed lymphohistiocytic infiltrates consistent with rheumatoid nodules. After surgery, the patient regained full function of the wrist within 2 weeks without any pain or remaining mass in the affected limb.
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Affiliation(s)
- Maurice Gillijns
- Department of Orthopaedic Surgery, AZ St-Dimpna Geel, Geel, Belgium
| | - Wim Vandesande
- Department of Orthopaedic Surgery, AZ St-Dimpna Geel, Geel, Belgium
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Bhat P, Khurana S, Fanaroff R, Adams SM, Rabinowitz RP. Rice body formation due to Haemophilus parainfluenza-associated chronic arthropathy. IDCases 2020; 23:e01030. [PMID: 33384928 PMCID: PMC7770526 DOI: 10.1016/j.idcr.2020.e01030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/09/2020] [Accepted: 12/13/2020] [Indexed: 11/18/2022] Open
Abstract
A 68-year-old woman with a medical history significant for psoriatic arthritis was found to have an enlarged, painful lump on her left hip 15 months after intramedullary rod placement for a left subtrochanteric femur fracture sustained in a fall. Histopathological findings showed rice body formation (RBF) with concurrent H. parainfluenza. RBF is a relatively rare arthropathy of a subset of chronic inflammatory disease such as rheumatoid arthritis or tuberculous arthropathy. RBF associated with psoriatic arthritis or orthopedic hardware placement has been reported in a handful of cases in the literature but there has not been any definitive evidence for RBF as a result of Haemophilus parainfluenza infections and is a rather unusual characteristic of this case.
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Affiliation(s)
- Pavan Bhat
- Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD, USA
- Corresponding author.
| | - Sahiba Khurana
- Department of Internal Medicine, MedStar Franklin Square Medical Center, Baltimore, MD, USA
| | - Rachel Fanaroff
- Department of Pathology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Scott M. Adams
- Orthopaedic Associates of Central Maryland, Catonsville, MD, USA
| | - Ronald P. Rabinowitz
- Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, The R. Adams Cowley Shock Trauma Center, Section of Infectious Diseases, Baltimore, MD, USA
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Jin Q, Zhou H, Lu H. Infiltration of synovitis into the flexor tendon: a case report. J Int Med Res 2020; 48:300060520936180. [PMID: 32779512 PMCID: PMC7425283 DOI: 10.1177/0300060520936180] [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] [Indexed: 11/24/2022] Open
Abstract
Synovitis is a type of aseptic inflammation that occurs within joints or surrounding tendons. No previous reports have described a hypertrophic synovium eroding the tendon sheath and manifesting as synovitis within the flexor tendon. We herein report a case involving a 10-year-old girl who presented to our hospital with a 1-month history of a swollen mass and progressive inability to completely flex her left index finger. The active flexion angle of the proximal interphalangeal joint was limited to 85°. A longitudinal incision of the flexor digitorum profundus tendon was surgically performed. The synovium inside and outside the flexor digitorum profundus tendon was completely removed. After the surgical excision, normal tendon gliding returned without recurrence by the 1-year follow-up. The active flexion angle of the proximal interphalangeal joint improved to 100°. To the best of our knowledge, this is the first case of synovitis affecting the flexor tendon and leading to limited flexion of a finger. The manifestation of a double ring sign on magnetic resonance imaging is quite characteristic. Early diagnosis and monitoring of the hyperproliferation and invasiveness of the synovial tissue are required. Surgical excision can be a simple and effective tool when necessary.
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Affiliation(s)
- Qianjun Jin
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P.R. China
| | - Haiying Zhou
- College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P.R. China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P.R. China
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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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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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Mass of the thenar eminence hiding idiopathic massive rice bodies formation with a compression of the median nerve: Case report and review of the literature. Int J Surg Case Rep 2018; 50:28-31. [PMID: 30071378 PMCID: PMC6080574 DOI: 10.1016/j.ijscr.2018.07.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/17/2018] [Accepted: 07/22/2018] [Indexed: 01/01/2023] Open
Abstract
Rice bodies are highly suggestive of tuberculous tenosynovitis and rarely found among non-tuberculosis patients. Synovial chondromatosis and pigmented Villonodular synovitis are differential diagnosis. MRI and routine histopathological examination are useful to establish the diagnosis. In our case, the key problem was the etiology of these rices bodies.
Introduction Rice bodies are described as fibrin bodies usually found among patients with inflammatory joint diseases, tuberculous arthritis, and tuberculous tenosynovitis, but they are rarely found among non-tuberculosis patients. Case presentation We report a case of a 69-year-old with a 2-year history of swelling and pain of the thenar eminence of the left hand with paresthesia in the territory of the median nerve. Surgical exploration revealed multiple rice bodies. Discussion Several authors have speculated on the nature of rice bodies. Their presence is highly suggestive of tuberculous tenosynovitis. One case of a primary brucellar tenosynovitis has been reported. In Morocco, brucellosis and tuberculosis remain a significant problem, with synovial chondromatosis and pigmented villonodular synovitis as differential diagnoses. Conclusion The patient had no history of tuberculosis, rheumatic disease, joint trauma, or infectious disease. Despite extensive evaluation, the etiology of the rice bodies could not be identified, and no underlying pathology was found.
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Saraya T, Fukuoka K, Maruno H, Komagata Y, Fujiwara M, Kaname S, Arimura Y, Yamada A, Takizawa H. Tenosynovitis with Rice Body Formation Due to Mycobacterium Intracellulare Infection After Initiation of Infliximab Therapy. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:656-662. [PMID: 29875354 PMCID: PMC6020799 DOI: 10.12659/ajcr.908785] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Patient: Female, 74 Final Diagnosis: Tenosynovitis Symptoms: Arthralgia • pain Medication: — Clinical Procedure: — Specialty: Infectious Diseases
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Affiliation(s)
- Takeshi Saraya
- Department of Respiratory Medicine, Kyorin University School of Medicne, Mitaka, Tokyo, Japan
| | - Kazuhito Fukuoka
- Department of Rheumatology and Nephrology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Hideto Maruno
- Department of Orthopedics, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Yoshinori Komagata
- Department of Rheumatology and Nephrology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Masachika Fujiwara
- Department of Pathology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Shinya Kaname
- Department of Rheumatology and Nephrology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Yoshihiro Arimura
- Department of Rheumatology and Nephrology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Akira Yamada
- Department of Rheumatology and Nephrology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Hajime Takizawa
- Department of Respiratory Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
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Cegarra-Escolano M, Jaloux C, Camuzard O. Rice-body formation without rheumatic disease or tuberculosis in a "sausage" ring finger. HAND SURGERY & REHABILITATION 2018; 37:S2468-1229(18)30067-7. [PMID: 29786532 DOI: 10.1016/j.hansur.2018.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/19/2018] [Accepted: 03/06/2018] [Indexed: 11/23/2022]
Abstract
Rice bodies are very unusual lesions, generally encountered in chronic synovitis due to rheumatoid diseases or tuberculosis. A 31-year-old right-handed man presented with a 15-year history of progressively growing "sausage-like" swelling of the 4th finger and palm of his right hand. There was an immovable, painless mass with restriction of the finger's ROM without local or general associated signs. Imaging showed a large non-aggressive mass within the tendon sheath. Complete excision of the mass was performed. Histopathological examination showed synovial villi with rice bodies and central necrosis suggestive of tuberculous synovitis or rheumatoid arthritis (RA). Tests for mycobacterial infections were all negative and there was no argument in favor of a rheumatoid pathology. There is no established standard treatment in a case like ours, which has no origin in tuberculosis or RA. Prolonged follow-up will be needed to confirm absence of recurrence after complete excision.
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Affiliation(s)
- M Cegarra-Escolano
- Department of Plastic and Reconstructive Surgery, University Center of Nice, Pasteur II Hospital, 30, voie Romaine, 06001 Nice, France.
| | - C Jaloux
- Department of Plastic and Reconstructive Surgery, University Center of Marseille, Conception Hospital, 147, boulevard Baille, 13005 Marseille, France
| | - O Camuzard
- Department of Plastic and Reconstructive Surgery, University Center of Nice, Pasteur II Hospital, 30, voie Romaine, 06001 Nice, France; UMR E-4320 TIRO-MATOs CEA/DRF/BIAM, Nice Sophia Antipolis University, 28, avenue de Valombrose, 06107 Nice cedex, France
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Nabet A, Faruqui S, Hogan CJ. Rice Bodies and a Partial Flexor Tendon Rupture in a Patient with Juvenile Idiopathic Arthritis: A Case Report and Review of the Literature. JBJS Case Connect 2017; 7:e41. [PMID: 29244679 DOI: 10.2106/jbjs.cc.16.00114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present a case of rice-body formation and partial flexor tendon rupture in a 3-year-old child with seronegative juvenile idiopathic arthritis (JIA), which presented as a painless soft-tissue mass of the volar aspect of the hand. The diagnosis was not confirmed until histologic examination. The patient was managed with a tenosynovectomy and oral medication; he made a full recovery. CONCLUSION JIA is one of the most common rheumatologic conditions of childhood. Establishing the diagnosis can be challenging in very young children, particularly when clinical presentation is atypical and serology is negative. Surgical intervention may be warranted in the appropriately selected patient with JIA.
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Affiliation(s)
- Austin Nabet
- Department of Orthopedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia
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Shin JJ, Lee JP, Kim DS. Multiple Rice Body Formation in Subacromial and Subdeltoid Bursal Spaces. Clin Shoulder Elb 2016. [DOI: 10.5397/cise.2016.19.2.96] [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] Open
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Lui TH. Dorsalis pedis psuedoaneurysm: A complication followed extensor tendoscopy of the ankle in a non-tuberculosis patient with tenosynovitis with rice body formation. Foot Ankle Surg 2016; 22:e1-5. [PMID: 27301738 DOI: 10.1016/j.fas.2015.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 11/29/2015] [Accepted: 12/02/2015] [Indexed: 02/04/2023]
Abstract
Tenosynovitis with rice body formation is very rare in the ankle region. A case of this condition in a non-tuberculosis patient was presented. He was treated by extensor tendoscopy of the ankle. The tenosynovitis subsided after the procedure. However, it was complicated by formation of a dorsalis pedis pseudoaneurysm.
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Affiliation(s)
- T H Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
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16
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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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17
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Li W, Xiao DM, Jiang CQ, Zhang WT, Lei M. Arthroscopic treatment of bony loose bodies in the subacromial space. Int J Surg Case Rep 2015; 11:101-103. [PMID: 25958049 PMCID: PMC4446658 DOI: 10.1016/j.ijscr.2015.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 02/02/2015] [Accepted: 02/02/2015] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Multiple bony loose bodies in the subacromial space caused form cartilage or bone cells and continue to grow. PRESENTATION OF CASE A 58-year-old man with two-year history of swelling and pain of the right shoulder. He had no history of tuberculosis and rheumatoid arthritis. Magnetic resonance (MR) images showed some bony loose bodies in the subacromial space. The removal of loose bodies and bursa debridement were performed arthroscopically. Histological diagnosis of them was synovitis with fibrous bodies. DISCUSSION Extra-articular loose bodies is extremely rare, especially in the subacromial space, which maybe originated in the proliferative synovial bursa. Most authors recommend open removal to relive the pain, but there were choice to apply arthroscopy to remove them. CONCLUSION The mechanism of formation of bony loose bodies is not clear, may be associated with synovial cartilage metaplasia. Arthroscopic removal of loose bodies and bursa debridement is a good option for treatment of the loose body in the subacromial space, which can receive good function.
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Affiliation(s)
- Wei Li
- The Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, Shen Zhen 518036, Guang Dong, PR China
| | - De-Ming Xiao
- The Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, Shen Zhen 518036, Guang Dong, PR China
| | - Chang-Qing Jiang
- The Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, Shen Zhen 518036, Guang Dong, PR China
| | - Wen-Tao Zhang
- The Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, Shen Zhen 518036, Guang Dong, PR China.
| | - Ming Lei
- The Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Lianhua Road 1120, FuTian District, Shen Zhen 518036, Guang Dong, PR China
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18
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Pimprikar MV, Kekatpure AL. Subdeltoid Bursa Tuberculosis with Rice Bodies Formation: Case Report and Review of Literature. J Orthop Case Rep 2014; 4:57-9. [PMID: 27298961 PMCID: PMC4719377 DOI: 10.13107/jocr.2250-0685.169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: We describe a rare case of a patient with unilateral musculoskeletal manifestation of tuberculosis presented as bursitis of the left shoulder with rice bodies, without coexisting active tuberculosis or tuberculosis in the previous history. Case Report: A 21 year old patient was examined, who complained of pain and swelling in the left shoulder for 2 years. MRI showed a large amount of rice bodies with joint effusion in the left shoulder with intact rotator cuff. The histological examination showed a tuberculosis-specific inflammatory response with giant cells and epithelioid granulomas. Arthroscopic debridement and removal of the loose bodies was done. A brief summary of the literature is given. Conclusion: We report a unique case of tuberculous subdeltoid bursitis with rice bodies formation in absence of any other concomitant focus of tuberculous infection, managed with arthroscopic debridement and anti -tuberculous regimen with a long follow up of twelve months.
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Affiliation(s)
- Milind V Pimprikar
- Director And Senior Consultant ADTOOS Clinics & Pimprikar Hospital Nasik. India
| | - Aashay L Kekatpure
- Consultant Shoulder And Elbow Surgeon ADTOOS Clinics & Pimprikar Hospital Nasik. India
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19
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Moreno S, Forcada P, Soria X, Altemir V, Gatius S, Gil M, Matías-Guiu X, Casanova JM, Martí RM. Tenosynovitis with rice body formation presenting as a cutaneous abscess. J Cutan Pathol 2014; 41:602-5. [PMID: 24673442 DOI: 10.1111/cup.12316] [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: 09/24/2013] [Revised: 12/19/2013] [Accepted: 02/09/2014] [Indexed: 11/29/2022]
Abstract
A 62-year-old woman with a past medical history of rheumatoid arthritis was referred to the Department of Dermatology because of an enlarging cutaneous lesion on the right thumb which resembled a soft tissue infection. She had received antibiotics without significant improvement. Clinical examination revealed an erythematous nodule involving almost the whole surface of the distal phalanx with spontaneous drainage of countless of small yellowish ovoid granules. Histopathologic study of these structures showed an inner core of amorphous acidophilic material with some interspersed chronic inflammatory cells and a surrounding thin fibrin layer. Special stains and cultures were negative for parasites, bacterium and mycobacterium. Magnetic resonance imaging (MRI) revealed distension of the first and fifth finger flexor sheaths and common finger flexor sheath. These areas were filled by fluid and multiple small nodular lesions. A diagnosis of non-infectious rice body tenosynovitis was rendered and surgical removal was performed. Total recovery was observed with no evidence of recurrence after 6 months of follow-up. To our knowledge, this is the first report of rice body tenosynovitis presenting as a pseudoinflammatory cutaneous lesion with evolution to a cutaneous fistula with drainage of rice grain-like structures. The description of this impressive and peculiar clinical and histopathologic picture is important to further recognize similar cases.
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Affiliation(s)
- Sara Moreno
- Department of Dermatology, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRB Lleida, Lleida, Spain
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20
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Rice body formation without rheumatic disease or tuberculosis infection: a case report and literature review. Clin Rheumatol 2012; 31:1753-6. [DOI: 10.1007/s10067-012-2063-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 08/09/2012] [Indexed: 11/27/2022]
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21
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Chien JT, Hsiao FT, Chen YC, Chen YH, Lay CJ, Tsai CC. Three cases of successful treatment of granulomatous tenosynovitis. Tzu Chi Med J 2011. [DOI: 10.1016/j.tcmj.2011.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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22
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Iyengar K, Manickavasagar T, Nadkarni J, Mansour P, Loh W. Bilateral recurrent wrist flexor tenosynovitis and rice body formation in a patient with sero-negative rheumatoid arthritis: A case report and review of literature. Int J Surg Case Rep 2011; 2:208-11. [PMID: 22096729 DOI: 10.1016/j.ijscr.2011.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Revised: 06/20/2011] [Accepted: 07/06/2011] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Rice body formation has been traditionally observed in the joint and tendon sheaths of patients with tuberculosis. Few case reports exist that describe rice body formation in patients with rheumatoid arthritis. We describe a case report of bilateral recurrent wrist flexor tenosynovitis with rice body formation in a patient with sero-negative rheumatoid arthritis. PRESENTATION OF CASE This case report describes a 72 year old lady presenting with severe bilateral, flexor tenosynovitis of the wrists. Ultrasonography revealed significant echogenic fluid on the palmer aspect of wrist joint surrounding flexor tendons with intact neurovascular bundles and no bony erosion. Laboratory tests demonstrated elevated erythrocyte sedimentation rate (50 mm/h) and negative rheumatoid factor. A sequential subtotal flexor tenosynovectomy was carried out with decompression of the carpal tunnel. During the operation, multiple rice bodies among the flexor tendons with adherent synovitis were found. Histology revealed disrupted synovial tissue containing several areas of fibrinoid necrosis, bounded by a layer of vaguely pallisaded histiocytes but no epitheloid granulomata or germinal centre. A revision surgery with debulking of the fibro-osseous canal was undertaken following recurrence. The patient presently has complete resolution of symptoms at one year follow-up. DISCUSSION The combined clinical, laboratory, ultrasound and histology findings of the patient indicated that the cause of the rice body formation was due to a sero-negative arthritis rather than tuberculosis. CONCLUSION Rice body formation can be caused by sero-negative arthritis. Bilateral wrist flexor tensosynovitis can recur within five months of a previous synovectomy in a patient with sero-negative arthritis.
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Affiliation(s)
- Karthikeyan Iyengar
- Southport District General Hospital, Town Lane, Southport, PR8 6PN, United Kingdom
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