Dear Dr Feinberg, your reply to my answer of December 10th has been very helpful, though the situation of the patient involved has got -it would seem- more complicated.... The young man was in fact taken into hospital to be treated with Bactrim administered intravenously. The doctors appear to have disagreed over the diagnosis and at no point, during a fortnight stay in hospital, has anybody characterized this condition by a name. After all kind of tests involving the heart, eyes, stomach, chest etc. were performed and which showed a healthy situation, they appear to have decided that the treatment was not working and that a new biopsy was required. When they opened up one of the "bumps" they said that it looked like atypical mycrobacterial infection. Since all of this has been going on at a distance and I am not too sure of what my friend understands or wants to understand, I am somewhat concerned. My worries are as follows: 1) is this TB related? 2) can it be treated? 3) how contagious would it be? The young man has been hospitalized in Germany, yet he works and lives in Italy and it would seem more sensible to try and find a leading virologist/ dermatologist in Italy. Could you suggest where to turn? As I already told you, his family does not know about him being gay and HIV+, and I appear to have become a sort of surrogate mother. If this is to be my role, I'd better know what to expect, how to behave and how to counsel best. With many thanks for your help and patience.
Various kinds of mycobacteria (a large family of bacteria that includes TB) can cause skin lesions. I have seen such lesions due to "MAC" (Mycobacterium avium complex), and others can behave similarly. These infections can be treated, although they require multiple (usually 3 or 4) drugs. It is not contagious. His response to treatment will be enhanced if he is also treated for his HIV infection. He needs to be in the hands of an HIV specialist. The clinic where he is being seen in Germany would be such a place, and there is a network of research-based HIV treatment sites in Italy sponsored by the Instituto Superiore di Sanita in Rome. The director of the ISS program for HIV/AIDS is Dr. Stefano Vella, and through his office I am sure you can locate the best HIV experts in Italy. Good luck!