Archives of Orthopaedic and Trauma Surgery - 2026-04-06 - Journal Article
Post-traumatic Candida infection leading to bilateral wrist rice body tenosynovitis: a case report and literature review.
Wang S, Ro H, Xu H, Fang L, Li X
Topics
Key Takeaway
Post-traumatic Candida tenosynovitis caused bilateral wrist rice body formation requiring two-stage debridement on the recurrent side, with complete resolution only after radical re-excision at 6 months.
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Summary
A 59-year-old man developed bilateral wrist flexor tendon sheath rice body tenosynovitis 10 months after a fall; MRI showed extensive synovial thickening and fluid, and fungal culture confirmed Candida species. Both wrists underwent surgical debridement with itraconazole therapy; the left wrist resolved, but the right recurred at 6 months requiring radical re-debridement. Complete resolution followed the second procedure, implicating incomplete initial synovectomy as the driver of recurrence rather than antifungal failure.
Key Limitation
Single case with no comparative data makes it impossible to determine whether itraconazole dosing, duration, or species-level susceptibility influenced the unilateral recurrence versus surgical incompleteness.
Original Abstract
BACKGROUND
Rice body tenosynovitis is a rare condition of uncertain etiology characterized by the formation of multiple fibrinous particles within the synovium or synovial fluid. It is frequently associated with chronic inflammation due to infection or rheumatoid arthritis and most commonly affects large joints such as the shoulder and knee. Simultaneous bilateral wrist involvement following trauma is exceptionally uncommon.
CASE PRESENTATION
A 59-year-old man presented with persistent bilateral wrist swelling for 10 months after a fall. MRI demonstrated extensive fluid accumulation and synovial thickening within the flexor tendon sheaths of both wrists. Surgical exploration revealed numerous yellow rice-like loose bodies and inflammatory proliferative tissue in the tendon sheaths. Pathology confirmed inflammatory granulation tissue with fibrinous exudate, and fungal culture identified Candida species infection. The left wrist recovered well after the initial surgery, but the right wrist recurred after 6 months and required a second thorough debridement, after which it resolved completely.
CONCLUSIONS
This report describes a rare case of bilateral wrist rice body tenosynovitis secondary to post-traumatic Candida infection with unilateral postoperative recurrence. It emphasizes that incomplete removal of inflammatory tenosynovium remains the primary cause of recurrence, even with targeted itraconazole antifungal therapy. Thorough exploration and radical excision of all inflammatory tissue and rice bodies during surgery are essential to prevent relapse.