Case 1

18-year-old boy treated since the age of 16 years due to T-cell acute lymphoblastic leukemia, relapse at the age of 17 years.

Underwent haploidentical hematopoietic stem cell transplantation (HSCT) from a partially HLA-matched (7/10) family donor – mother Posttransplant history complicated with:

• Severe steroid-resistant acute graft versus host disease with skin and gut involvement
• Multiple viral infections (CMV infection, BKV haemorrhagic cystitis, adenovirus)
• Renal failure

The patient developed numerous, small and then confluent wounds on the skin of the face, mainly around the eye sockets and on the cheeks. The changes exacerbated during antibiotic therapy and on treatment with caspofungin with posaconazole. A suspicion of hyalohyphomycosis (fusariosis) was raised. Voriconazole infused dressings were applied twice daily. Systemically, the patient was treated with teicoplanin, meropenem, metronidazole, posaconazole and Ambisome.

On September 22, the lesions were cleaned, material for collected for microbiological cultures, pathological examinations. Skin cultures showed MRS cutaneous staphylococci, no fungal infiltrations were found.

Within 2 weeks since initiation of treatment, complete resolution of the lesions was achieved.

The results of the histopathological examination were released but the cause of the skin changes was not found.

• Severe steroid-resistant acute graft versus host disease with skin and gut involvement
• Multiple viral infections (CMV infection, BKV haemorrhagic cystitis, adenovirus)
• Renal failure