Aspergillus spondylodiscitis successfully treated with a long course of isavuconazole

We present a case of spondylodiscitis caused by Aspergillus fumigatus, which we successfully treated with isavuconazole after voriconazole severe intolerance. Aspergillus spondylodiscitis is a severe and relatively rare form of extra-pulmonary invasive aspergillosis. Typically, voriconazole is the first-choice antifungal drug for treating Aspergillus osteomyelitis or spondylodiscitis. However, isavuconazole, a new antifungal medication, has been demonstrated as non-inferior to voriconazole in cases of invasive aspergillosis. It has the added benefits of fewer hepatobiliary, ocular, and cutaneous side effects. It generally does not demand serum level monitoring and poses fewer risks of drug interactions. Nonetheless, there are no studies yet that support its use in spondylodiscitis, and published experiences are very limited and based on isolated cases, albeit mainly positive. The case we present here aims to provide additional evidence on the efficacy and tolerability of isavuconazole in treating this condition.