Objective Unraveling the underlying molecular defect in a patient with early onset progressive leukoencephalopathy and combined OXPHOS deficiency involving complex I and II. Methods After homozygosity mapping and whole exome sequencing a candidate gene was identified. Pathogenicity was assessed by means of functional studies in HeLa cells and western blotting in patient material. Results In a patient presenting with psychomotor retardation, massive white matter alterations and the presence of high lactate were detected on MRI, and a combined complex I and II deficiency was found in skeletal muscle. This combined complex deficiency is very suggestive of a defective iron-sulfur cluster (ISC) biosynthesis, a suspicion which was further strengthened by absence of lipoic residues in aKGDH and PDH. Homozygosity mapping revealed several candidate genes involved in ISC biogenesis: NFU1, BOLA3, IBA57 and ABCB10. Whole exome sequencing identified a homozygous variant in IBA57 [c.436C> T. (p.Arg146Trp)]. Complementation studies in HeLa cells depleted of wild type IBA57 and transfected with mutant IBA57 showed deficient lipoylation and lowered expression of a complex II subunit. Conclusion By combining a biochemical and molecular approach the underlying genetic cause for this patient's phenotype could be unraveled. This is the third report of a pathogenic variant in IBA57 and discloses the clinical and neuroradiological heterogeneity of this gene defect. At the biochemical level a combined complex I and II deficiency and absence of lipoylation seems to be a uniform finding.