Rheumatoid subacromial-subdeltoid bursitis with rice bodies: A case report

Abstract

Subacromial-subdeltoid bursitis of a shoulder with rice bodies is relatively uncommon. The understanding of the pathogenesis of rice body formation is yet approximate only but some clinical conditions like rheumatoid arthritis, tuberculous arthritis, seronegative inflammatory arthritis, juvenile rheumatoid arthritis and osteoarthritis are related to it. We describe a case of a 44 years old female with subacromial-subdeltoid bursitis of her right shoulder with numerous rice bodies' formation as a presenting feature of rheumatoid arthritis. She underwent subacromial and subdeltoid bursectomy with the removal of rice bodies and had immediate improvement of symptoms.

Keywords: Osteochondomatosis; Rheumatoid arthritis; Rice bodies; Subacromial-subdeltoid bursitis; Tuberculous bursitis.

Fig. 1

Globular swelling at subacromial region over right shoulder.

Fig. 2

USG showing fluid filled distended thick walled subacromial–subdeltoid bursa with multiple intrabursal non-shadowing echogenic nodular lesions.

Fig. 3

a & 3b: Coronal T2-weighted MRI images of right shoulder showing distended subacromial–subdeltoid bursa filled with fluid and multiple small well defined hypointense intrabursal loose bodies.

Fig. 4

Post contrast axial MRI image of right shoulder showing distended subacromial–subdeltoid bursa with thickened enhancing wall.

Fig. 5

Numerous pea sized loose bodies (Rice Bodies) extruding out.

Fig. 6

a & 6b: Inflamed Subrachnoid-subdeltoid bursa removed completely with all loose bodies.

Fig. 7

Histopathological sections showing a. presence of lymphoid follicle in synovial tissue, b. chronic inflammatory cell infiltrate, infiltrating synovial tissue, c. neuronal hyperplasia, d. synovial giant cell and e. central dense homogenous acellular area in section from rice body.