Mycobacterium intracellulare Tenosynovitis with Rice Body Formation with Literature Review

Area of Science:

• Rheumatology
• Infectious Diseases
• Orthopedic Surgery

Background:

• Rice body formation is an uncommon manifestation of chronic synovial inflammation.
• Typically associated with rheumatoid arthritis and tuberculosis, rare cases involve non-tuberculous mycobacteria.
• This study focuses on a unique case of rice body formation due to Mycobacterium intracellulare.

Observation:

• A 69-year-old male presented with a six-month history of pain and swelling in his third finger following a wire puncture injury.
• Magnetic resonance imaging revealed synovial thickening, fluid collection, and rice bodies along the flexor tendon.
• Surgical exploration confirmed multiple rice bodies within the tendon sheath from the carpal bone to the distal phalanx.

Findings:

• Mycobacterial culture identified Mycobacterium intracellulare as the causative agent.
• The patient received a treatment regimen including rifampin, ethambutol, and clarithromycin.
• No recurrence of symptoms or rice body formation was observed post-treatment.

Implications:

• This case expands the differential diagnosis for rice body formation.
• It underscores the importance of considering atypical mycobacterial infections in tenosynovitis, especially after penetrating injuries.
• Early diagnosis and appropriate antibiotic therapy are crucial for successful management and preventing recurrence.