PROGRESSION, INVESTIGATIONS AND TREATMENT:
Surveillance imaging 13 months post orchidectomy in 2017 with computed
tomography (CT) abdomen pelvis (Figure 1) demonstrated disease
recurrence and progression to metastatic testicular seminoma stage 2B,
with evidence of a new 37mm para-aortic lymph node. Positron Emission
Tomography (PET) imaging confirmed an isolated glucose avid lesion
consistent with a site of active disease. He was referred for
radiotherapy due to concerns for LHON conversion secondary to
cisplatin-based chemotherapy (BEP). The patient was deemed not suitable
for radiotherapy given unacceptable levels of left kidney irradiation
required due to the extent of macroscopic disease and the tumour
proximity to the renal hilum. The patient elected not to receive
bleomycin given his uncle’s reported conversion following exposure to
glycopeptide antibiotic therapy and case reports of conversion in the
literature following erythromycin, instead receiving four cycles of
cisplatin and etoposide. High dose intravenous vitamin C was
administered during the last week of each chemotherapy cycle, with a
previous study reporting a benefit of supplementation in LHON. This was
in addition to regular supplements Idebenone 500 mg daily and Coenzyme
Q10 150 mg twice daily, taken in consultation with his
neuro-ophthalmologist during treatment cycles.