Fettuccine with Creamy Tomato Italian Sausage Sauce

All I had to do was read the ingredient list of this recipe and my father was half-way out the door to the store to buy the fettuccine. Normally either one of “a pound of Italian sausage” or “a cup of whipping cream” is enough to pique his interest. Both together and the recipe takes on its own gravitational force. “Make me… make me..”

My father found this recipe in a back issue of Bon Appetit. It is rich, it is not for every day, but my oh my is it good, and so easy to make! The sauce comes together quickly with sweet and spicy Italian sausage, first cooked through then simmered with tomatoes and cream.

Fettuccine with Creamy Tomato Italian Sausage Sauce Recipe

  • Prep time: 6 minutes
  • Cook time: 45 minutes
  • Yield: Serves 6.


  • 2 Tbsp olive oil
  • 3 shallots, chopped
  • 2 large garlic cloves, chopped
  • 1/2 pound sweet Italian sausage, casings removed
  • 1/2 pound spicy or hot Italian sausage, casings removed
  • 1 cup whipping cream
  • 2 14.5-ounce cans diced tomatoes in juice
  • 1 Tbsp dried sage
  • 3/4 pound fettuccine
  • 1/2 cup grated Parmesan cheese


1 Put a large pot of salted water on to boil (1 Tbsp salt for every 2 quarts of water). While the pasta water is heating, prepare the sauce in the next step.

2 Heat olive oil in a large sauté pan on medium heat. Add the shallots and garlic and cook, stirring frequently, until beginning to soften, about 3 minutes. Break up the sweet and spicy Italian sausages as you add them to the pan. Toss with the shallots, increase the heat to medium high, and cook until no longer pink, about 5 minutes. Stir in the cream and simmer for 5 minutes. Stir in the tomatoes, their juices, and the sage. Simmer for about 15 minutes, stirring occasionally, until the sauce thickens.

3 The pasta water should be boiling by now. After the sauce has simmered for about 5 minutes, add the pasta to boiling salted water and cook, uncovered at a rolling boil, until the pasta is al dente, cooked through but still a little firm to the bite. Reserve 1/2 cup of the pasta water and drain the pasta.

4 Toss the pasta with the sauce and add a little of the reserved pasta water if dish seems dry.

Season with salt and pepper and sprinkle with cheese to serve.

Hello! All photos and content are copyright protected. Please do not use our photos without prior written permission. If you wish to republish this recipe, please rewrite the recipe in your own unique words and link back to the source recipe here on Simply Recipes. Thank you!

Never miss a recipe!

Subscribe to Simply Recipes free via email:

Showing 4 of 88 Comments

  • Stephenie

    I made this dish for my boyfriend, who is somewhat weary of any dish that is too heavy. He loved this dish! So did I for that matter. I was told from my roommate, who had the leftovers, that the dish looked and tasted like something that she gets from the Italian restaurant she works in. I’ll be making this again for sure!

  • Lisa Forsyth

    My Husband loved this! He had the leftovers for lunch the following day and he hates leftovers. Excellent!

  • Chip

    As the lucky beneficiary of this sausage-cream gravitational force, I can vouch for its goodness (and for its affinity with full-bodied red wine, several glasses of which do tend to make me talk more than usual about stone fruit). I’ll look forward to a pluot tart recipe this summer.

  • Nicky

    Delectable dish! I used a pound of ground sweet Italian sausage for a milder flavor, and it was superb. Grilled asparagus and White Merlot rounded out the goodness. Great site!

View More Comments / Leave a Comment