Giant Bursitis of Wrist and Multiple Tenosynovitis of Hand with Rice Body Formation: Unusual Case of an Atypical Mycobacteria Infection

Abstract

We report an unusual manifestation of nontuberculous mycobacterial infection characterized by a giant bursitis on wrist and multiple tenosynovitis with many rice bodies formations. The clinical and radiological examinations are neither rather sensitive nor rather specific. The nuclear imagery of rice bodies formations provides elements of guidance. Cause of absence of the germ isolation, diagnosis was retained on probability items based on a suspicion of arguments beam: clinical, biological, bacteriological and histological. The patient was treated with medical and surgical procedure and provided a satisfactory evolution. At follow-up of 15 months, there were no clinical signs of local recurrence. Through a literature review, the problem of diagnosis of certainty will be discussed.

Nontuberculous Mycobacterial Infection Mimicking Inflammatory Tenosynovitis: A Real Head Scratcher

“…Rice bodies are small fibrin bodies that can be seen with chronic synovium inflammation, rheumatoid arthritis, tubercular mycobacterial infection, atypical mycobacterial infection, and osteoarthritis to name a few. In our case, the rice bodies involved extensor tendon sheaths and joint spaces were spared, which was more in favor of NTM/tubercular tenosynovitis [ 1 , 5 ].…”

“…These infections are indolent in contrast to pyogenic bacterial infections which lead to delay in the diagnosis leading to an increase in morbidity [ 5 ]. Imaging modalities are nonspecific both in the early and late stages and could resemble other reactive/inflammatory/granulomatous pathologies [ 2 ].…”

“…Therefore, a low threshold for suspicion with repeated tissue diagnosis, including AFB stain and culture, is needed for diagnosis as presented in this case. Debridement is equally essential along with the adequate duration of combination medical therapy for appropriate treatment and wound healing [ 4 , 5 ].…”