[Slowly progressive, non-traumatic swelling of the left ankle. What does this have to do with rice grains?]

This case illustrates the diagnostic approach to chronic arthropathy or tendinopathy. Based on the most common causes, initial evaluation should primarily include imaging and rheumatological assessment. Depending on the results, patients may be managed in primary care or referred to an appropriate specialist. In this patient, extended investigations revealed tuberculous rice body tenosynovitis. After surgical treatment and nine months of antituberculous therapy, an excellent clinical outcome was achieved.