Italy's captain, Sergio Parisse, has declared himself unfit for their first World Cup clash, against France at Twickenham next weekend.
The 31-year-old Argentine-born No 8, capped 112 times by Italy and their star player, has not fully recovered from surgery to drain a haematoma last Monday.
He picked up the injury, a swelling of clotted blood in his left leg, in Italy's Cup warm-up defeat to Wales in Cardiff last weekend.
Italian rugby bosses initially said Parisse would not meet up with the Italy team in Rome at the weekend but would instead link up "at a later date" in England.