Isavuconazole Therapy for Nasal-Cerebral Mucormycosis with High Isavuconazole MIC.

Mucormycosis is a severe infection that requires prompt antifungal therapy. Although liposomal amphotericin B (L-AMB) is the standard treatment, its toxicity may limit its use. We report the case of a patient with diabetes mellitus and rhinocerebral mucormycosis who developed brain abscesses despite L-AMB and surgical interventions. After switching to isavuconazole (ISCZ) and continuing surgical management and optimization of underlying conditions, clinical and radiological improvements were observed. Although partial maxillary bone loss occurred during follow-up, the ISCZ was continued for more than one year without adverse events, and the patient remained clinically stable. Notably, although the isolate showed an ISCZ MIC >8 μg/mL, a clinical improvement was observed with multidisciplinary management.