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

Rationale: 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. Patient concerns: 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. Diagnoses: 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. Interventions: Surgical exploration and synovectomy were performed, various intra-articular bodies were removed, and the affected tissues were debrided. Outcomes: The patient recovered well after surgery, with significant symptom relief and improved joint function. No recurrence was observed during 8 months of follow-up. Lessons: 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.