Fettuccine with Creamy Tomato Italian Sausage Sauce

Fettuccine pasta with a rich and creamy, tomato and Italian sausage sauce. Absolute crowd pleaser.

Fettuccine with Creamy Tomato Italian Sausage Sauce
Elise Bauer

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

Prep Time 6 mins
Cook Time 45 mins
Total Time 51 mins
Servings 6 servings


  • 2 tablespoons extra virgin 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 tablespoon dried sage
  • 3/4 pound fettuccine
  • 1/2 cup grated Parmesan cheese


  1. Heat water for pasta:

    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. Cook shallots and garlic:

    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.

  3. Add Italian sausage:

    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.

  4. Stir in the cream:

    and simmer for 5 minutes.

  5. Stir in the tomatoes, their juices, and the sage:

    Simmer for about 15 minutes, stirring occasionally, until the sauce thickens.

  6. Cook the pasta:

    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.

  7. 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.