Italy suffered late World Cup heartache as a late Diego Godin header enabled Uruguay to leapfrog them into second place of Group D and subsequently seal qualification for the knockout stages in Brazil.
Coach Cesare Prandelli called on his full complement of Juventus players for the crunch fixture, fielding Gigi Buffon between the posts, Andrea Barzagli, Leonardo Bonucci and Giorgio Chiellini across the defence and Claudio Marchisio and Andrea Pirlo in midfield.
It was the latter who went closest to breaking the deadlock in a cagey opening period, forcing Fernando Muslera to beat a well-struck free-kick over the crossbar on 13 minutes.
Uruguay, featuring Bianconeri defender Martin Caceres in their ranks, remained a threat on the break and the Azzurri had to rely on the razor-sharp reflexes of captain Buffon, who first denied Luis Suarez then Nicola Lodeiro with a magnificent double stop just past the half-hour mark.
Fourteen minutes into the restart, Italy found themselves down to 10 men after Marchisio was shown a straight red card for a challenge on Egidio Arevalo.
The numerical advantage raised Uruguayan hopes of producing the goal they required to take them out of Group D, and Suarez again went close, only to be denied by another fine Buffon stop when one-on-one with the goalkeeper.
The Azzurri, who had every reason to feel aggrieved after seeing their appeals for what appeared to be a blatant Suarez red card fall on deaf ears, then suffered what ultimately proved the knockout blow when Godin rose to head home from a corner on 81 minutes.