Case 147

Male child, 3 years and 6 months old, with acute lymphoblastic leukemia, had a fever peak (38°C) due to phlebitis in the right arm, where the peripheral venous access was, during the first cycle of chemotherapy. Antibiotic therapy was initiated with Cefepime and blood was drawn for culture. After 17 hours of incubation, there was a growth of Gram-positive cocci in pairs and clusters and after 24 hours, of yeast cells as well. Vancomycin and Amphotericin B were associated to the antibiotic therapy, without the appropriate response. Other than the persistent fever, the patient presented with multiple cutaneous lesions that evolved as depicted in the photographs.

Question:
According to the story and the pictures provided, what is the most probable fungal infection?