Case—A 27-year-old female with hypocellular myelodysplastic syndrome underwent matched unrelated donor allogeneic stem cell transplantation in July 2011. She presented with diarrhoea 3 weeks after transplant and was diagnosed as acute graft versus host disease of the gut. She did not respond to steroids and was treated with infliximab (antiTNFα monoclonal antibody), pentostatin and abatacept (CTLA4-IgG fusion protein) with minimal response.She developed dark-coloured necrotic-appearing papules on her skin (Figure 1) which were biopsied. Culture plate showed grayish-black colonies (Figure 2). Septated hyphae with sporulation were noted on microscopy (Figure 3). Figure 1. Patient with papules on her face Figure 2. Sabouraud agar plate with grayish black colonies Figure 3. Lactophenol Cotton Blue Wet mount preparation showing septate hyphae with sporulation (magnification 40×) What is the diagnosis? Answer and Discussion