An adult with non-sex-linked congenital hypogammaglobulinemia who developed knee swelling is described. This patient had marked synovial proliferation and rice body formation without inflammatory synovial fluid and no infiltration of the synovium by lymphocytes or other inflammatory cells. Traditionally, rice bodies have been considered a nonspecific response to inflammatory synovial disease. The occurrence of rice bodies in the setting of noninflammatory joint disease suggests a dichotomy between the inflammatory and proliferative reactions in synovitis.