Bring a large pot of salted water to a boil and cook the pasta al dente according to package instructions. Save ½ cup of pasta water.
Heat olive oil in large pan over medium heat and add the sausage, breaking up and cooking for 4-5 minutes or until browned. Add the shallots, cooking for 1-2 minutes before adding the garlic and cooking for another 30 seconds.
Add the wine, scraping up any brown bits and cooking for a minute. Add the cream and nutmeg, cooking for 1-2 minutes or until thickened. Remove from heat.
Add the pasta, cheese and a few shavings of black truffle to the sauce as well as ¼ cup of reserved pasta water, tossing to combine. Add more pasta water and adjust seasoning if needed. Serve with more grated cheese and shave truffles if desired.
Notes
Make sure the water you are cooking the pasta in is salted as some of the flavor comes from it.
DO NOT overcook the pasta when boiling. You want it just al dente or slightly under. It continues to cook with the sauce.
Use quality dry white wine to deglaze the pan. You want a wine you’d be willing to drink as it adds flavor and acidity to the sauce.
Don't use pre-shredded cheese. You want if finely grated so it melts well. Pre-shredded has added ingredients that will just make it clump up.
The truffle can be omitted if you prefer. I like it as it adds some extra richness to the dish. You can replace with truffle oil or mushrooms.