1
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Tian Y, Hu J, Xia Q, Han D. Rice body synovitis in systemic lupus erythematosus. Rheumatol Int 2024; 44:1773-1779. [PMID: 37632525 DOI: 10.1007/s00296-023-05426-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/07/2023] [Indexed: 08/28/2023]
Abstract
Rice bodies (RBs) synovitis in the shoulder joints of systemic lupus erythematosus patients is a rare clinical condition that has not been previously reported. Despite the fact that the diagnosis of RBs synovitis has primarily relied on MRI imaging, ultrasound has been used less frequently. In this report, we discuss a 43-year-old female diagnosed with systemic lupus erythematosus who presented with pain and swelling in the right shoulder. The ultrasound findings were typical, and the patient was diagnosed with RBs synovitis, as she had no history of tuberculosis or rheumatoid arthritis. Subsequently, the patient underwent ultrasound-guided percutaneous biopsy and surgical excision, which led to a good postoperative outcome. Based on this case, a literature review of RBs synovitis over the past 2 decades indicates that rice bodies synovitis is rare in clinical presentation accompanied by SLE. Moreover, ultrasound has not been extensively employed for diagnosing this condition. It is important to note the pivotal role of ultrasound in detecting RBs synovitis, and it should be the preferred method for early detection. Therefore, ultrasound physicians should be well informed about this condition to enhance diagnostic precision.
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Affiliation(s)
- Youyou Tian
- Department of Ultrasound Diagnosis, Daping Hospital, Army Military Medical University, 10 Changjiang Branch Road, Yuzhong District, Chongqing, 400022, China
- Department of Ultrasound Diagnosis, Yinjiang Autonomous Country Hospital, Yinjiang Autonomous Country, Tongren, Guizhou Province, China
| | - Jiayin Hu
- Department of Ultrasound Diagnosis, Daping Hospital, Army Military Medical University, 10 Changjiang Branch Road, Yuzhong District, Chongqing, 400022, China
| | - Qin Xia
- Department of Ultrasound Diagnosis, Daping Hospital, Army Military Medical University, 10 Changjiang Branch Road, Yuzhong District, Chongqing, 400022, China
| | - Dong Han
- Department of Ultrasound Diagnosis, Daping Hospital, Army Military Medical University, 10 Changjiang Branch Road, Yuzhong District, Chongqing, 400022, China.
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2
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Tuan HX, Huyen NT, Hung ND, Anh NTH, Duc NM. Imaging features of shoulder tuberculosis with rice bodies formation: A case report. Radiol Case Rep 2024; 19:1608-1613. [PMID: 38333900 PMCID: PMC10850118 DOI: 10.1016/j.radcr.2024.01.043] [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: 11/28/2023] [Revised: 01/11/2024] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
Osteoarticular tuberculosis is less common than pulmonary tuberculosis and is often overlooked in the differential diagnosis of people with joint disease. In this article, we present a case of a 71-year-old female patient admitted to the hospital because of pain and limited movement of her right shoulder for a year. The patient had diabetes for 10 years, and no history of tuberculosis or previous history of tuberculosis exposure. Blood test results showed inflammatory condition and positive IGRA test. X-ray, ultrasound and magnetic resonance imaging images revealed osteolytic and sclerotic lesions of the humeral head, diffuse thickening of the synovial membrane, and loose bodies in the joint and bursa. The clinical diagnosis was tuberculous inflammatory osteoarthritis of the right shoulder. The patient underwent arthroscopy surgery to remove loose bodies and the inflamed portion of the synovium and send them to the pathology department. Histopathological examination of the loose bodies and synovial membrane revealed features suggestive of tuberculosis of the shoulder joint. Afterward, the patient was treated with antituberculosis drugs according to the guideline and rehabilitation exercises. After 3 months of treatment, the clinical symptoms were reduced, the pain rating was decreased and the range of motion was increased.
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Affiliation(s)
- Ho Xuan Tuan
- Department of Radiology, Bach Mai Hospital, Hanoi 100000, Vietnam
| | - Nguyen-Thi Huyen
- Department of Radiology, Bach Mai Hospital, Hanoi 100000, Vietnam
| | - Nguyen Duy Hung
- Department of Radiology, Hanoi Medical University, Hanoi 100000, Vietnam
- Department of Radiology, Viet Duc Hospital, Hanoi 100000, Vietnam
| | - Nguyen-Thi Hai Anh
- Department of Radiology, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 700000, Vietnam
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3
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El-Rosasy MA, Elrosasy AM, Khaled A. Carpal Tunnel Syndrome Secondary to Tuberculous Tenosynovitis With Rice Bodies: A Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00041. [PMID: 37267417 DOI: 10.2106/jbjs.cc.23.00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
CASE We report the case of a 34-year-old African man who presented with severe symptoms of recurrent left carpal tunnel syndrome (CTS) and left hand swelling after previous open decompression. Considering the recurrent unilateral affection of the left hand in a patient working in a slaughterhouse in an area with a moderate burden for tuberculosis, tuberculous infection was suspected. Open surgery and biopsy revealed tuberculous tenosynovitis of flexor tendon sheath and shiny white rice bodies. CONCLUSION Tuberculous tenosynovitis should be considered as a differential diagnosis of the CTS when there is evidence of proliferative tenosynovitis in patients from an endemic area for tuberculosis.
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Affiliation(s)
- Mahmoud A El-Rosasy
- Department of Orthopedic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Abdullah Khaled
- Department of Orthopedic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
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4
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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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Yushan M, Yalikun A, Hamiti Y, Lu C, Yusufu A. Clinical features and treatment outcome of wrist tuberculosis in adult- a retrospective study of 84 consecutive cases with minimum of 2 years follow up. BMC Musculoskelet Disord 2022; 23:618. [PMID: 35761223 PMCID: PMC9238136 DOI: 10.1186/s12891-022-05563-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Wrist tuberculosis (TB) is a rare disease that may result in residual deformity, pain, or stiffness even after proper antitubercular chemotherapy (ATT) and surgical intervention. The aim of our study is to present clinical features and functional outcomes of wrist TB in a consecutive series of 84 adult patients with a minimum of 2 years of follow-up.
Methods
Clinical features and treatment outcomes of 84 consecutive adult patients with wrist TB from January 2003 to June 2018 including 45 men and 39 women, with a mean age of 46.8 years (18–84) were retrospectively analyzed. Data were collected on participants’ demographic details. The primary outcome measures were QuickDASH score, grip strength, Visual Analogue Scale (VAS), and PRWHE. Secondary outcomes include health-related quality of life was evaluated using the EuroQol five-dimension five-level (EQ-5D-5L), assessment and postoperative complications of patients who underwent operation were also recorded.
Results
All 84 patients with an average follow-up of 50.8 (24–105) months. The mean duration of symptoms before treatment was 10.5 months (2–21). There were 27 patients with bony and 57 with primarily soft-tissue involvement based on preoperative evaluation of plain radiographs and MRI. There were 33 patients treated with ATT and 51 patients were treated with surgery followed by ATT. Among them, 13 patients (15.5%) underwent incision and decompression, 14 patients (16.7%) underwent wrist synovectomy, 13 patients (15.5%) underwent wrist joint fusion by plate fixation, and 11 patients (13.1%) underwent wrist joint fusion by external fixation. At the last clinical visit, the QuickDASH, and PRWHE scores of all patients decreased significantly, the VAS improved from 5.9 to 1.4, EQ-5D-5L utility index improved from 0.36 to 0.88, EQ-VAS improved from 40.2 to 89.1. All patients indicated good wrist recovery at the last follow-up, and the treatment achieved satisfactory clinical outcomes.
Conclusion
The onset of wrist TB is insidious; early diagnosis, good patient compliance, and surgery combined with ATT are crucial steps for treatment of wrist TB, and also essential for the patient's postoperative recovery. Wrist arthrodesis has achieved satisfactory results in the treatment of severe wrist TB.
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PosthumaDeBoer J, Torrekens M, Nuffel MV. Synovial Chondromatosis of the Midcarpal Joint: A Case Report and Brief Review of Literature. J Wrist Surg 2022; 11:177-180. [PMID: 35478946 PMCID: PMC9038309 DOI: 10.1055/s-0041-1726405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Abstract
Objective Synovial chondromatosis is a rare benign proliferative disorder of synovium characterized by the formation of cartilaginous bodies in a joint. The condition typically affects one single large joint. The development of synovial chondromatosis in the joints of hand and wrist is extremely rare. Case description In this report, we present a case of synovial chondromatosis arising from the midcarpal joint and the arthroscopic treatment thereof. Literature review Owing to its rarity, literature on synovial chondromatosis occurring in the hand and wrist is extremely limited. To our knowledge, no report has been published describing the arthroscopic treatment of an isolated synovial chondromatosis of the midcarpal joint. Clinical relevance As synovial chondromatosis of the hand and wrist is extremely rare, and clinical and radiological findings can be nonspecific, the diagnosis might be overlooked initially. The condition does, however, require surgical treatment and thorough follow-up. Thus, awareness of this possible diagnosis among treating physicians is important.
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9
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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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10
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Altaf W, Attarde D, Sancheti P. Tubercular compound palmar ganglion presenting as a severe carpal tunnel syndrome- A case report. J Clin Orthop Trauma 2020; 11:S889-S891. [PMID: 32999574 PMCID: PMC7503147 DOI: 10.1016/j.jcot.2020.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 10/23/2022] Open
Abstract
Atypical presentation of tuberculosis is not uncommon in developing countries. Among extra-pulmonary sites, tendons are very rarely involved. Compound palmar ganglion associated with tuberculosis is an uncommon condition in which a swelling is present across the wrist joint on either side of the flexor retinaculum. Very rarely such lesion can compress over neural structures and may present as Carpal Tunnel Syndrome. A therapeutic challenge consists of treating disease and its associated presentation. Treatment of choice for such conditions include complete excision of the mass along with the radical synovectomy of the wrist joint and associated flexor tendon sheaths followed by anti-tubercular medications. With early diagnosis and treatment good recovery can be achieved. We present a Case of a large compound tubercular palmar ganglion who presented to us with symptoms of carpal tunnel syndrome which was treated surgically with excision and carpal tunnel release.
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Affiliation(s)
- Warid Altaf
- Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India
| | - Dheeraj Attarde
- Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India,Corresponding author.
| | - Parag Sancheti
- Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India
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Abstract
Mycobacterial hand infections are uncommon. These infections have an indolent course and are marked by variable and nonspecific presentations, often leading to diagnostic and treatment delays. The pathogens involved in mycobacterial hand infections include Mycobacterium tuberculosis complex, atypical mycobacteria, and M leprae. Initial treatment involves a combination of long-term antibiotics and surgical débridement to cure the infection. Reconstructive procedures aid in restoring hand function lost secondary to the disease.
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Affiliation(s)
- Abdo Bachoura
- The Philadelphia Hand to Shoulder Center, Thomas Jefferson University Hospital, 834 Chestnut Street, Suite G114, Philadelphia, PA 19107, USA
| | - David S Zelouf
- The Philadelphia Hand to Shoulder Center, Thomas Jefferson University Hospital, 834 Chestnut Street, Suite G114, Philadelphia, PA 19107, USA.
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12
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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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13
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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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Tuberculous Arthritis of the Knee with Rice Body Formation: A Report of a Rare Case. Case Rep Orthop 2020; 2020:6369781. [PMID: 32089932 PMCID: PMC7021457 DOI: 10.1155/2020/6369781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 12/18/2019] [Indexed: 11/17/2022] Open
Abstract
In this report, we present the case of a 53-year-old man with rice body formation in the right knee caused by tuberculous arthritis (TB arthritis). The patient visited our hospital in January 2018 with a seven-month history of swelling and pain in the right knee. He had no previous history of tuberculosis, and the results of the routine laboratory tests were within normal limits; he also tested negative for rheumatoid factor. Magnetic resonance (MR) imaging revealed multiple rice bodies in the right knee, measuring 5-8 mm. He underwent an arthroscopic operation in the right knee in January 2018 and received antituberculosis polytherapy for 6 months. He was followed-up for more than 01 year. The patient regained good function of the operated knee with no evidence of recurrence during the last follow-up in February 2019. Conclusion. The biggest challenge in diagnosing tuberculosis arthritis is the consideration of its possibility in the differential diagnosis, not only in endemic countries where tuberculosis is frequent. A high level of suspicion for TB should be maintained for every infection of the knee joint, particularly in the case of intra-articular rice bodies.
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15
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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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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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18
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Flexor Tenosynovitis Due to Tuberculosis in Hand and Wrist: Is Tenosynovectomy Imperative? Ann Plast Surg 2017; 77:169-72. [PMID: 26418769 DOI: 10.1097/sap.0000000000000603] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The treatment of flexor tenosynovitis in the hand and wrist due to tuberculosis is controversial. Although some authors recommend the antituberculous chemotherapy, the others recommend the surgical treatment. In this article, 12 patients with synovial tuberculosis of the flexor aspect of the hand and the wrist were evaluated with respect to diagnosis and treatment modalities. None of the patients had a history of tuberculosis, concomitant disease, immunosuppressive drug use, drug abuse, and human immunodefficiency virus positivity. A chest x-ray and family screening were performed in all of the cases, none had evidence of tuberculosis in the lung. The biopsy, histopathological examination, acid-fast bacillus staining, and BACTEC tuberculosis culture were performed. Antituberculous chemotherapy was initiated in patients diagnosed with tuberculosis by either histological or microbiological examinations. The patients did not undergo any further surgery after biopsy procedures. The lesions regressed totally in all patients after 3 months of treatment. Carpal tunnel syndrome symptoms and signs recruited at five months of treatment. In patients with flexor tuberculosis tenosynovitis, it is possible to achieve good results by applying only medical therapy after a biopsy, and without the need for further surgery.
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19
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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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20
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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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21
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Lluch A, Barrera-Ochoa S, Cortina J, Mir-Bullo X. Brucellosis as a Primary Cause of Flexor Tenosynovitis on the Hand: Case Report and Literature Review. J Hand Microsurg 2014; 7:140-2. [PMID: 26078527 DOI: 10.1007/s12593-014-0122-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 02/07/2014] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alex Lluch
- Hand Surgery Unit. Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain ; Traumatology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain ; Hand Surgery, Institut Kaplan, Barcelona, Spain
| | - Sergi Barrera-Ochoa
- Traumatology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain ; Hand Surgery and Microsurgery Unit, Hospital Universitari Quiron-Dexeus. ICATME, Barcelona, Spain ; ICATME. Hospital Universitari Quiron-Dexeus, Sabino de Arana 5-19, 08028 Barcelona, Spain
| | - Josep Cortina
- Traumatology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Xavier Mir-Bullo
- Hand Surgery Unit. Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain ; Traumatology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain ; Hand Surgery and Microsurgery Unit, Hospital Universitari Quiron-Dexeus. ICATME, Barcelona, Spain
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Jeong YM, Cho HY, Lee SW, Hwang YM, Kim YK. Candida septic arthritis with rice body formation: a case report and review of literature. Korean J Radiol 2013; 14:465-9. [PMID: 23690715 PMCID: PMC3655302 DOI: 10.3348/kjr.2013.14.3.465] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 02/06/2013] [Indexed: 11/15/2022] Open
Abstract
Rice body formation in a joint or bursa is a rare condition, and is usually associated with rheumatoid arthritis or tuberculous arthritis. Here we describe a case of multiple rice body formation in a shoulder joint and in adjacent bursae, which was confirmed to be due to septic arthritis by Candida species. To the best of our knowledge, rice body formation in Candida septic arthritis in an immune-competent patient has not been previously reported.
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Affiliation(s)
- Yu Mi Jeong
- Department of Radiology, Gachon University, Gil Hospital, Incheon 405-760, Korea.
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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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25
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Reverté Vinaixa MM, Singh R, Monyart JM, Llado GD, Dominguez MP, Feliu EC, Nardi Vilardaga J, Palou EC. Wrist synovial chondromatosis: case report and literature review. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2012; 17:233-8. [PMID: 22745090 DOI: 10.1142/s0218810412720239] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 11/19/2011] [Accepted: 11/21/2011] [Indexed: 11/18/2022]
Abstract
Primary synovial chondromatosis is a proliferation of cartilaginous bodies within the synovial membrane, tendon sheath or bursa. It is a rare orthopaedic entity especially when it occurs in the distal radioulnar joint. We report a 27-year-old man with recurrent synovial chondromatosis, nine years after his first operation. Although rare, synovial chondromatosis must be considered in the differential diagnosis in a patient with pain and swelling of the distal radioulnar joint. From our literature review, we report a 17% (5/30) recurrence rate for synovial chondromatosis involving the wrist joint which has not been documented in the medical literature previously.
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Rice Bodies, Millet Seeds, and Melon Seeds in Tuberculous Tenosynovitis of the Hand and Wrist. Ann Plast Surg 2011; 66:610-7. [DOI: 10.1097/sap.0b013e3181e35ca5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Ergun T, Lakadamyali H, Aydin O. Multiple rice body formation accompanying the chronic nonspecific tenosynovitis of flexor tendons of the wrist. ACTA ACUST UNITED AC 2008; 26:545-8. [DOI: 10.1007/s11604-008-0270-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Accepted: 07/15/2008] [Indexed: 11/30/2022]
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29
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Lin KM, Lai JH, Chang CC, Lin CK, Chang DM, Chen CH. Formation of numerous rice bodies: an unusual finding of adult-onset Still's disease. Clin Rheumatol 2008; 27 Suppl 2:S55-7. [PMID: 18509715 DOI: 10.1007/s10067-008-0900-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 04/03/2008] [Indexed: 11/30/2022]
Abstract
Adult-onset Still's disease (AOSD) is an inflammatory disorder characterized by high-spiking fever, arthritis, and an evanescent rash. The pattern of chronic arthritis is a universal feature of AOSD. However, chronic bursitis with the formation of numerous rice bodies is a very rare presentation in a patient with AOSD. To our knowledge, no case of formation of numerous rice bodies in AOSD has been reported thus far. We describe the case of a 28-year-old man with AOSD with rice bodies in his left shoulder joint.
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Affiliation(s)
- Kang-Min Lin
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan, Republic of China
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