Fig. 1

Disease timeline. In summary, our patient received two cycles of cisplatin, bleomycin, and etoposide and then platinum, etoposide, and ifosfamide for two cycles with some dose reduction of ifosfamide in cycle 4. His beta-human chorionic gonadotropin was 5.3 IU/L after four cycles of cisplatin, bleomycin, and etoposide/platinum, etoposide, and ifosfamide treatment. A computed tomography scan done 1 month after completing chemotherapy demonstrated significant improvement and only a few subcentimeter pulmonary nodules along with necrotic lymph node within his pericardium. Post-therapy, his beta-human chorionic gonadotropin further decreased to 3.2 IU/L. On a follow-up visit 4 months after chemotherapy, his beta-human chorionic gonadotropin went up to 635 IU/L. He was considered for salvage with TIGER trial-based paclitaxel, ifosfamide, carboplatin, and etoposide regimen. AFR alpha-fetoprotein, BEP cisplatin, bleomycin, and etoposide, bhCG beta-human chorionic gonadotropin, CT computed tomography, HDCT high-dose chemotherapy, LDH lactate dehydrogenase, SOB shortness of breath