Rice Bodies, Millet Seeds, and Melon Seeds in Tuberculous Tenosynovitis of the Hand and Wrist

Abstract

Tuberculosis (TB) is still endemic in many developed countries. Involvement of the hand and wrist at presentation is extremely rare, and the diagnosis is often missed. Operative findings of "rice bodies, millet seeds, or melon seeds" are highly suggestive of tuberculous tenosynovitis. Six patients with TB of the hand and wrist at various stages of disease with characteristic operative findings are reviewed. Four patients had underlying immunosuppression. One patient had previous pulmonary TB, whereas 3 patients had radiographic evidence of previously undiagnosed pulmonary TB. The interval to presentation ranged from 1 week to 2 years. Two patients had median nerve irritation, 3 patients had osteomyelitis, and 1 patient had flexor tendon rupture. Mycobacterial cultures were positive in 4 patients; acid-fast bacilli stain, and polymerase chain reaction were positive in remaining 1 patient; and both stain and culture were negative in the last patient who had history of pulmonary TB. All 6 patients were managed with combination therapy comprising antituberculous chemotherapy and at least 1 debulking tenosynovectomy. Two patients had 2 debridements. Of these 2 patients, 1 underwent wrist arthrodesis during the second procedure. Mean follow-up was 4 years. There were no recurrences after the most recent debridement. The diagnosis of TB of the hand and wrist is often missed. The surgeon has to be aware of the significance of loose bodies when performing routine excision of innocuous looking wrist ganglia. Combination therapy comprising thorough excisional debridement and antituberculous chemotherapy will minimize recurrence of this difficult-to-treat disease.

Mycobacterium arupense Flexor Tenosynovitis: Case Report and Review of Antimicrobial Susceptibility Profiles for 40 Clinical Isolates

“…An infectious etiology was suspected due to the asymmetric involvement and the patient's failure to respond to disease-modifying antirheumatic agents. Magnetic resonance imaging (MRI) showed diffuse severe tenosynovitis of the wrist and hand and innumerable enhancing loculations with hypointense foci suggestive of multiple "rice bodies" (1,2). Pathology from a tenosynovial biopsy specimen showed marked chronic inflammation with no giant cells or granulomas.…”

Tuberculous Tenosynovitis of the Wrist Mimicking a Volar Wrist Ganglion Cyst and Carpal Tunnel Syndrome

“…In addition, rice bodies can also be observed in cases of systemic lupus erythematosus (SLE), seronegative arthritis, infectious arthritis (TB, atypical mycobacterial infection) nonspecific arthritis, and osteoarthritis (OA). [14][15][16][17][18][19] However, Woon et al [20] reported that finding rice bodies along with millet seed or melon seed-shaped lesions is highly suggestive of tuberculous tenosynovitis. They also suggested that the surgeon has to be aware of the significance of loose bodies when performing a routine excision of innocuous looking wrist ganglia.…”

Compound palmar ganglion associated with tuberculous arthritis of wrist causing compression of the median and ulnar nerves: Management

“…Our case represents the second stage of tuberculous tenosynovitis. Woon et al 14 reported that findings of rice body, millet or melon seed body intra-operatively are highly indicative of tuberculous tenosynovitis. 14 The wide range of differential diagnosis and poor clinical awareness often leads to delay in arriving at clinical diagnosis and subsequent treatment, leading to complications.…”

“…Woon et al 14 reported that findings of rice body, millet or melon seed body intra-operatively are highly indicative of tuberculous tenosynovitis. 14 The wide range of differential diagnosis and poor clinical awareness often leads to delay in arriving at clinical diagnosis and subsequent treatment, leading to complications. Differential diagnosis of compound palmar ganglion includes inflammatory arthritis (rheumatoid arthritis, gouty arthritis), sarcoidosis, infective (pyogenic infections, foreign body tenosynovitis, fungal granuloma) and other lesions of the tendon sheath (pigmented villonodular synovitis, giant cell tumour, amyloidosis and synovial chondromatosis).…”