A light and ultrastructural study of rice bodies recovered from a case of date thorn-induced extra-articular synovitis

Candida parapsilosis-Caused Arthritis with Rice Body Formation: A Case Presentation and Literature Review

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.

Rice Bodies in Children with Rheumatic Disorders: A Case Series and Systematic Literature Review

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.

Stenosing tenosynovitis with rice bodies formation diagnosed by ultrasound: A case report

RATIONALE

Rice bodies are usually found in several nonspecific chronic inflammatory diseases that are symptomatically dominated by primary disease and local compression symptoms. Rice bodies are usually detected by magnetic resonance imaging; however, some remote areas and areas with poor economic conditions do not have access to magnetic resonance imaging examination, which leads to delayed diagnosis of the disease.

PATIENT CONCERNS

We report the case of a 62-year-old man with pain in the metacarpophalangeal joint of his right middle finger and limited flexion activity of his middle finger.

DIAGNOSES

The mass was 1 cm, well-circumscribed, soft, and painless. Ultrasound showed stenosing tenosynovitis with rice body formation.

INTERVENTIONS

The patient underwent tenosynovectomy with synovectomy of the right middle finger tendon sheath under plexus block anesthesia.

OUTCOMES

No postoperative complications were noted. A 6-month follow-up showed no recurrence. The activity of the patient's middle finger improved significantly.

LESSONS

Stenosing tenosynovitis with rice body formation is a very rare condition, and we use ultrasound for diagnosis. Ultrasound is convenient, rapid, inexpensive, and can obtain blood flow information, facilitate disease follow-up, and even allow ultrasound localization in advance for guided needle biopsy.

Subdeltoid Rice Bodies in a Patient with Rheumatoid Arthritis on Disease Modifying Antirheumatic Drug Therapy: A Case Report

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.

Idiopathic tenosynovitis with rice bodies

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.

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

•

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.

[Tuberculous rice body synovitis of the shoulder joint]

The clinical presentation of synovitis with rice bodies is found in a few systemic diseases as accompanying manifestations within joints or joint-associated bursa. A 79-year old patient was examined, who had complained of pain and swelling in the left shoulder for a long time. Sonography identified multiple spindle-shaped joint bodies within the joint effusion. MRI showed a large amount of so-called rice bodies with joint effusion in the shoulder and a massive destruction of the rotator cuff of the left shoulder. The histological examination showed a tuberculosis-specific inflammatory response with giant cells and epithelioid granulomas and molecular biological detection of Mycobacterium tuberculosis. Within a few months after surgical removal of the rice bodies from the joint space and the bursa a relapse occurred with repeated synovial effusion followed by a renewed surgical removal of the joint bodies. We describe the rare case of a patient with unilateral musculoskeletal manifestation of tuberculosis presented as synovitis of the left shoulder and the adjacent bursa with rice bodies and accelerated growth trend without coexisting active tuberculosis or tuberculosis in the previous history. Furthermore, a brief summary of the literature is given.

Tenosynovitis with rice body formation in a non-tuberculosis patient: a case report

In this report, we present a 68-year-old man with rice body formation in the flexor tendon sheath of the fingers without any inflammatory diseases such as tuberculosis or rheumatoid arthritis. The patient visited our institute in March 2004 with a one-month history of swelling and pain of the right distal forearm. Laboratory data were within normal limits, and the rheumatoid factor was negative. He had no history of tuberculosis, and the tuberculin reaction was weakly positive. Magnetic resonance (MR) images showed a mass measuring 6 cm x 4 cm around the flexor tendons of the forearm. Many rice bodies had been erupted from a small hole of the fibrous wall of the mass at the time of incisional biopsy performed in June 2004. Histological diagnosis was synovitis with fibrous loose bodies. In July 2004, spontaneous ruptures of the right fourth and fifth flexor tendons occurred. Open repair was performed in August 2004. The patient regained good function of the operated fingers with no evidence of recurrence at the latest follow-up in March 2009.