Peyton Stearns was sick during and after her match against Naomi Osaka at the Italian Open. The American star came through an intense battle 6-4 3-6 7-6 (7-4) to book her place in the quarter-finals on what is her first appearance in the WTA 1000 tournament.

However, the 23-year-old was anything but jubilant afterwards. Instead, she looked exhausted as she steadied herself against a giant courtside tennis ball. Stearns then bent over and threw up before being tended to by officials.

It wasn't the first time the world no.42 had vomited during the clash. Stearns was also sick moments before the decisive final set tie-break, but then shook off her illness to hold her nerve in a thrilling finale.

She appeared uncomfortable as she left court, but did manage to wave and salute the crowd. It remains to be seen whether she'll play her scheduled doubled match this afternoon with Daria Kasatkina against Erin Routliffe and Gabriela Dabrowski.

The Cincinnati-born player has been impressive in Rome, beating Nuria Brancaccio and Anna Kalinskaya in straight sets to set up a clash with fifth seed Madison Keys. That match also went to a deciding tie-break, which Stearns won 7-3.

It's not the first time Stearns has struggled with ill-health at a tournament this year. At the Dubai Tennis Championships in February, she collapsed in the corridor after her two-hour 35-minute victory over Qinwen Zheng.

Despite this, due to a rejigged schedule following rain delays, hours later, she was forced to play another match against Mirra Andreeva. Clearly struggling, she fell to a heavy defeat.

She later made light of the incident, posting a photo on X of her flat on the back after going down, with the caption: "Highly don’t recommend having a GI illness & playing 2 matches in a day… not a good combo."