This morphology justifies the etymology neither of the name ��Trophy��, from the Greek (food), and ��Eryma�� (barrier), that literally is ��obstacle to absorption of food��, with a latency period for the onset of symptoms of six years (9). The disease is epidemiologically linked to a fecaloral transmission, mostly of male patients which work with animals, but the proportion between female and male is rising, also because of a genetic predisposition or W.D. has been discussed (2). The clinical evolution towards intestinal obstruction requires antibiotic treatment with Trimethoprim and Sulfomethoxazole, a full dose continued for 1�C2 years (1,7,9) or until complete regression of the disease.

Treatment with tetracycline revealed cases of recurrence in 40% of patients with neurological symptoms and involvement of CNS (21), whereby for these patients is required an antibiotic therapy with ceftriaxone, 2 grams for 2 weeks, followed by oral cotrimaxazole, 2 times daily for 1�C2 years, in consideration of the ability to overcome the blood-barrier of these antibiotics (14). The antibiotic treatment reduces the clinical symptoms, especially diarrhea, fever and malabsorption in 1 week, while the rest of clinical signs tend to decrease in 3�C4 weeks. Gastroscopy with duodenal biopsy within 6�C12 months from the onset of antibiotic treatment allows a proper follow-up (25). Conclusions The W.D. confirms to be a rare multisystemic condition with different clinical onset most frequently affecting the gastrointestinal system (60�C90%), the skeleton with arthritis and polyarthralgia of large joints (70 %) and neurological signs (15�C20 %).

The gastroscopy with duodenal biopsy is mandatory for the diagnosis of W.D., above all when the gastrointestinal system is involved. The biopsy evidences are: thickening of the intestinal wall, a widened villi, lymphatic occlusion of vessel and lipid deposit in the lamina of the wall, which allows the identification of the bacteria or remnants of bacteria in the foamy macrophages with vesicles PAS-positive. The differential diagnosis with others intestinal infections (Mycobacterium avium, corynebacterium, Rhococcus and so on), which shows PAS-positive macrophages, is possible using molecular diagnosis with RNA polymerase, which has a higher specificity for the T.W.

The intestinal obstruction requires an emergency surgical treatment with ileostomy for massive swelling and edema of intestinal loops, which do not allow a valid segmental resection. Given the very high risk of fistula in this case, the AA consider also appropriate to proceed to intestinal recanalization only Batimastat after complete remission of the pathology. The antibiotic treatment of choice is a full parenteral dose for 2 weeks of trimethoprim and sulfometathaxazole in the initial stages of disease, followed by maintenance therapy for 1�C2 years or so, until complete remission of clinical signs.