Toxic epidermal necrolysis after allogeneic hematopoietic stem cell transplantation for refractory Hodgkin’s lymphoma.

progressed.CPI-nivolumab was then initiated with CR3 on a PET scan after the 15 th cycle.Three months after the last dose of nivolumab, he underwent allo-HSCT from a 10/10 HLA-matched unrelated donor.Fludarabine (total dose 150 mg/m 2 IV) and busulfan (total dose 8 mg/kg IV) were used for conditioning, and he received tacrolimus and mycophenolate mofetil for GVHD prophylaxis.The early post-transplant period was complicated by a maculopapular rash covering <50% of the body.He was diagnosed with aGVHD grade 1 according to the Mount Sinai Acute GVHD International Consortium (MAGIC) [4].Topical treatment with clobetasol and intravenous methylprednisolone pulses were administered, acheiving rapid and significant improvement.Two weeks later, he was admitted to the Regional Hematology Unit for recurrent dysuria.At the same time his skin lesions had worsened and progressed to erythroderma and epidermolysis.Methylprednisolone at 500 mg daily was initiated, and the tacrolimus dose was adjusted to the blood trough level.Unfortunately, extensive erythematous lesions with severe epidermal peeling covered his whole body.Moreover, flaccid vesicles with serous content were visible on the feet (Fig. 1A,B).Nikolsky's sign was positive.The complete blood count was normal.Biochemistry revealed elevated lactate dehydrogenase (LDH).Despite the treatment, no improvement was demonstrated, and the patient was admitted to our University Center.Immunosuppressants were slowly tapered.After scrutinized analysis including dermatological consultation, the patient was diagnosed with TEN limited to the skin only.During his stay in our department, CMV and other viral infections were routinely monitored and