Moreno Sara, Forcada Pau, Soria Xavier, Altemir Victoria, Gatius Sonia, Gil Mabel, Matías-Guiu Xavier, Casanova Josep M, Martí Rosa M
Department of Dermatology, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRB Lleida, Lleida, Spain.
J Cutan Pathol. 2014 Jul;41(7):602-5. doi: 10.1111/cup.12316. Epub 2014 Mar 7.
A 62-year-old woman with a past medical history of rheumatoid arthritis was referred to the Department of Dermatology because of an enlarging cutaneous lesion on the right thumb which resembled a soft tissue infection. She had received antibiotics without significant improvement. Clinical examination revealed an erythematous nodule involving almost the whole surface of the distal phalanx with spontaneous drainage of countless of small yellowish ovoid granules. Histopathologic study of these structures showed an inner core of amorphous acidophilic material with some interspersed chronic inflammatory cells and a surrounding thin fibrin layer. Special stains and cultures were negative for parasites, bacterium and mycobacterium. Magnetic resonance imaging (MRI) revealed distension of the first and fifth finger flexor sheaths and common finger flexor sheath. These areas were filled by fluid and multiple small nodular lesions. A diagnosis of non-infectious rice body tenosynovitis was rendered and surgical removal was performed. Total recovery was observed with no evidence of recurrence after 6 months of follow-up. To our knowledge, this is the first report of rice body tenosynovitis presenting as a pseudoinflammatory cutaneous lesion with evolution to a cutaneous fistula with drainage of rice grain-like structures. The description of this impressive and peculiar clinical and histopathologic picture is important to further recognize similar cases.
一名62岁有类风湿关节炎病史的女性因右手拇指上一处不断增大、类似软组织感染的皮肤病变被转诊至皮肤科。她接受了抗生素治疗，但病情无明显改善。临床检查发现一个红斑结节，几乎累及远节指骨的整个表面，有无数小黄ish卵形颗粒自发排出。对这些结构的组织病理学研究显示，内部为无定形嗜酸性物质核心，有一些散在的慢性炎症细胞，周围有一层薄的纤维蛋白层。特殊染色和培养对寄生虫、细菌和分枝杆菌均为阴性。磁共振成像（MRI）显示第一和第五指屈肌腱鞘以及指总屈肌腱鞘扩张。这些区域充满液体和多个小结节性病变。诊断为非感染性米粒样腱鞘炎，并进行了手术切除。随访6个月后观察到完全恢复，无复发迹象。据我们所知，这是首例米粒样腱鞘炎表现为假性炎症性皮肤病变并演变为皮肤瘘管且有米粒样结构排出的报告。对这种令人印象深刻且独特的临床和组织病理学表现的描述对于进一步识别类似病例很重要。
