Non-tuberculous Mycobacterium or Fungus Induced Chronic Tenosynovitis with Rice Body of the Hand

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.

Non-tuberculosis Mycobacterium Tenosynovitis with Rice Bodies in a Patient with Systemic Lupus Erythematosus

“…Rice bodies caused in tenosynovitis are reported in rheumatoid arthritis, tuberculosis, and NTM infection ( 1 ). The pathogenesis of rice body formation remains unclear, but experts have suggested that they arise from microinfarcted synovium or that the early rice body appears de novo and causes progressive enlargement by fibrin deposition ( 13 ).…”

“…Infectious arthritis in SLE often resembles a disease flare and hence is difficult to diagnose. Rice-body formations, which could be detected by imaging modalities such as magnetic resonance imaging (MRI), have been reported in non-tuberculosis mycobacterium (NTM) tenosynovitis ( 1 , 2 ). We herein report a case of refractory arthritis in an SLE patient, who was diagnosed with NTM tenosynovitis after the detection of rice bodies on MRI and the confirmation of Mycobacterium chelonae on a lower temperature tissue culture.…”

What’s New in Musculoskeletal Infection

“…Pyogenic tenosynovitis was observed to have worse outcomes when the organism was Staphylococcus and when antimicrobial therapy was delayed 119 . Kanavel signs were observed to be sensitive but not specific 120 , and in 1 center's experience, when rice bodies were found in chronic tenosynovitis, the causative organism was often NTM, fungus, or unidentified 113 .…”

What’s New in Musculoskeletal Infection: Update on Biofilms

“…Pyogenic tenosynovitis was observed to have worse outcomes when the organism was Staphylococcus and when antimicrobial therapy was delayed 119 . Kanavel signs were observed to be sensitive but not specific 120 , and in 1 center's experience, when rice bodies were found in chronic tenosynovitis, the causative organism was often NTM, fungus, or unidentified 113 .…”

“…Atypical infections caused by Mycobacterium tuberculosis (TB) [103][104][105][106][107] , nontuberculous mycobacteria (NTM) 104,[108][109][110][111][112][113] , and fungi 104,[114][115][116][117] were associated with delays in diagnosis, and the authors suggest a need for a heightened index of suspicion 103,104,110 , and when ordered, 2.4% of cultures were positive for acid-fast bacilli (AFB) and 5.3% were positive for fungi 104 . M. marinum is the most common NTM, but several other species were also investigated [108][109][110]112,113 . Clinical findings were described, and about half of the cases occurred in healthy hosts who had no apparent portal of entry or causative event 103,107,111 .…”