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.