Tubercular Tenosynovitis of Extensor Tendons of Ankle : A Case Report

Introduction:India being an endemic region for Tuberculosis (TB) has a high incidence of musculoskeletal TB with various presentations. Tenosynovitis is a rare presentation and few cases have been reported involving the hand and wrist but isolated involvement of extensor tendons at the ankle is even rarer and unreported. Case Report:Thirty-five-year-old female patient presenting with a dumbbell-shaped swelling over the anterolateral aspect of right ankle with mild dull aching pain. MRI revealed altered signal intensities surrounding the extensor tendons at the ankle without the involvement of the joint. Surgical debridement was done and six-month ATT was given. Gross specimen revealed rice bodies and histopathological examination showed caseous necrosis and epitheloid cell granulomas. Conclusion:Tuberculosis TB being endemic can have varied presentations, early diagnosis can be made if clinical suspicion for TB is considered. ATT is the mainstay of treatment, but surgical debridement is necessary for extensive lesions with compressive symptoms. Keywords:Tuberculosis, tenosynovitis, rice bodies, dumbbell dumbbell-shaped mass.

Rice Bodies In The Wrist

Rice bodies are a rare finding in medicine and remain to be a challenge to provide adequate treatment. As 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 more rare. 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 digitorum tendons as well as the flexor pollicis longus tendon. Laboratory test were negative for rheumatology tests with normal CRP and sedimentation rates. T2 weighted MRI 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, no atypical cells were discovered. After surgery the patient regained full function of the wrist within two weeks without any remaining pain or mass in the affected limb.

CHRONIC NONSPECIFIC TENOSYNOVITIS OF FLEXOR TENDON SHEATH (WITH RICE BODIES) IN THE HAND- TEN YEARS FOLLOW UP.

Rice bodies are fibrous bodies resembling grains of rice. They are associated with many inflammatory conditions like rheumatoid arthritis, tuberculosis, juvenile arthritides, seronegative arthritis, osteoarthritis, septic joints and chronic bursitis. Rice bodies are seen in pleural fluid, in the setting of bursitis and within the tendon sheath. We describe a rare case of Rice body tenosynovitis of flexor tendon sheath of a finger in a hand that showed no evidence of any infection or rheumatic disease after repetitive diagnostic procedures. Case presentation: We report a case of forty-nine-year-old fisherman presenting with progressive, painless sausage shaped swelling of right hand middle finger for two years. Discussion: Rice bodies are formed in inflammatory joint diseases and mostly with tuberculous etiology but rarely found in non-tuberculous patient. This a case of Rice body formation associated with chronic Nonspecific tenosynovitis of middle finger right hand. Conclusion: Rice bodies in the distal palm to digital flexor tendon sheath of Right-hand middle finger with no specific etiology are extremely rare clinical Presentation. MRI, radiography and histopathology were useful in arriving at a Diagnosis. Over the period of 10 years, only one flexor tendon sheath of right hand middle finger was affected, without any other disability. Since his occupationis fishing, may be bite of the fish may be a reason. This chronic inflammation of the middle finger tendon sheath of the flexor tendon was confined only to that finger over the past 10 years. Now after complete excision of the sheath, he is free of this problem and is able to continue his profession without any difficulty.