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Three elderly people were killed when fire swept through a hospital overnight in the town of Tivoli, close to Rome, Italian media reported on Saturday.
A fourth body was found in the mortuary of the San Giovanni Evangelista hospital but that victim was believed to have died before the blaze broke out shortly before 23:00 (22:00 GMT) on Friday night, Italy's Ansa news agency said.
The fire brigade used turntable ladders to help evacuate around 200 people from the hospital, including a pregnant woman and a number of children.
Those evacuated were taken to hospitals in other parts of Rome for treatment. The dead - two men and two women - were aged between 76 and 86, the media reports said.
The fire brigade said that the fire had now been put out and an investigation was under way to establish its cause.
