Complete resolution of primary sclerosing peritonitis ("abdominal cocoon") following long term therapy for Tropheryma whipplei: a case report and review of literature.

A 53-year-old man was admitted to our internal medicine unit with intestinal obstruction and signs of systemic inflammatory disease. Clinical history was unremarkable until a few months earlier, when he began suffering from Achilles tendonitis. Diagnostic procedures, including laparotomy, revealed diffuse thickening of the peritoneum resembling sclerosing encapsulating peritonitis. Biopsies showed reactive fibrosis. No known secondary causes were found and surgery was technically not feasible. Clinical conditions worsened daily until, on the basis of the overall spectrum of clinical and radiological findings, Whipple's disease was hypothesised and specific therapy administered, with prompt clinical improvement. Complete disappearance of the cocoon was demonstrated at 1 year clinical/ultrasound/computed tomography follow-up.