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.