Rice body synovitis of the wrist mimicking tuberculosis in an HIV-positive patient: A case report

Rice body synovitis is a rare benign synovial disorder with an insidious onset and nonspecific clinical features that often lead to diagnostic uncertainty or delay.

A 68-year-old woman with human immunodeficiency virus infection and a history of cured pulmonary tuberculosis presented with right wrist pain and swelling for 3 years, which had worsened over the preceding 2 months. She also reported limited motion and a palpable mass.

Preoperative imaging showed moth-eaten bone destruction, peri-articular abscesses, joint space narrowing, and intra-articular rice bodies, raising a strong suspicion of tuberculous arthritis. However, intraoperative assessment and histopathological analysis confirmed rice body synovitis and found no evidence of Mycobacterium tuberculosis infection or granulomatous inflammation.

Surgical exploration and synovectomy were performed, various intra-articular bodies were removed, and the affected tissues were debrided.

The patient recovered well after surgery, with significant symptom relief and improved joint function. No recurrence was observed during 8 months of follow-up.

In regions where tuberculosis is prevalent, clinicians should avoid diagnosing tuberculous synovitis solely based on intra-articular bodies or radiographic abnormalities, even in high-risk patients. Histopathological evaluation is essential for definitive diagnosis and appropriate management.