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We present the case of a 63-year-old patient suffering from myelodysplasia with excess blast-2 (MDS-EB2) and undergoing a sibling hematopoietic stem cell transplantation. On CT evaluation prior to the transplant procedure, diverticula were found at the sigmoid level. The patient performed myeloablative conditioning regimen with thiotepa 10 mg/kg, busulfan 9.6 mg/kg and fludarabine 160 mg/m², simultaneously with ATG therapy, as per existing literature indications. At day +2 from the hematopoietic stem cell infusion, the patient's clinical condition progressively worsened (Karnofsky performance status scale 30%), with febrile episodes, treated with empiric antibiotic therapy, and numerous episodes of daily diarrheal discharges. Copro-culture and parasitological test were performed, not finding particular microorganisms capable of exacerbating this intestinal manifestation. Mucositis was diagnosed, also involving the oral cavity (WHO grade 3) and the esophageal mucosa, making it impossible for the patient to take liquids and solids. On day +9, diarrheal discharges continued (up to 10 per day, not responsive to supportive therapies), leading to the evacuation of a piece of intestinal mucosa of about 5 cm, edematous and erythematous, with excavated lesions, mixed with blood and feces (Figures 1 and 2). In fact, inflammation of almost all the mucous membranes is an important complication related to the transplant conditioning regimen, debilitating for the patient and capable of significantly increasing the risk of associated mortality. Prompt diagnosis, careful monitoring of vital parameters and appropriate care are essential to ensure the best possible care of immunosuppressed transplant patient.