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Two years after his promotion in the senior team, he was called back in the U21 squad for the 2019 UEFA European Under-21 Championship on home soil.

Pellegrini scored his first goal with the Italy senior side on 5 September 2019, in a 3–1 away win over Armenia in a Euro 2020 qualifier.

On 30 June 2017, Roma exercised the buy back clause of €10 million, which was included in Pellegrini's transfer agreement with Sassuolo, to bring him back to Rome on a five-year deal. On the same day Roma youth product Federico Ricci joined Sassuolo outright, for €3 million fee. Pellegrini scored his first-ever goal for the club on 1 December 2017, netting Roma's third goal in a 3–1 league win over SPAL.

He made his first appearance for the senior side in an 8–0 victory over San Marino in an unofficial friendly match on 31 May 2017, coming on as a half time substitute for Daniele Baselli. His official debut followed on 11 June when he appeared in Italy's 5–0 home win over Liechtenstein in a 2018 World Cup qualifier.

Later that month, he was included in the Italy under-21 squad for the 2017 UEFA European Under-21 Championship by manager Luigi Di Biagio. On 18 June, he scored the nation's first goal at the tournament, netting from a bicycle kick in a 2–0 win over Denmark. Italy were eliminated in the semi-finals following a 3–1 defeat to Spain on 27 June; during the match, Pellegrini assisted Federico Bernardeschi's temporary equaliser.

Born in Rome, Pellegrini, who had suffered from arrhythmia as a youngster, joined the youth academy of local side Roma at the age of nine. Having previously represented the club in the UEFA Youth League, he was handed his senior debut at the age of 18 by manager Rudi Garcia on 22 March 2015, coming on as a second-half substitute for Salih Uçan in a 1–0 Serie A win over Cesena.

On 30 June 2015, Pellegrini signed for fellow Serie A side Sassuolo for a fee of €1.25 million. In terms of the transfer agreement, Roma retained a buy-back-clause which afforded the club the opportunity to re-purchase Pellegrini at a future stage. He made his debut for the club on 8 November 2015, starting in a 1–0 league win over Carpi, and scored his first goal the following month when he netted in a 3–0 win over Sampdoria. He ultimately made 20 appearances for the season, including one in the Coppa Italia, and scored three goals. During the 2016–17 season, Pellegrini became the youngest player to have a hand in 10 goals in a single Serie A campaign, having registered six goals and four assists by 10 April 2017. He made 34 appearances across all competitions for the campaign, scoring eight goals registering seven assists, before re-signing for Roma at the end of the season.

Pellegrini has represented Italy at various youth levels. He made his debut for the U19 side against Germany in March 2014. He then enjoyed a brief spell with the U20's in 2015 before making his U21 debut against France on 2 June the following year.

Lorenzo Pellegrini (Italian pronunciation: [loˈrɛntso pelleˈɡriːni] ; born 19 June 1996) is an Italian professional footballer who plays as a midfielder for Serie A club Roma and the Italy national team. He is an academy graduate of Roma, having joined the club in 2007, and made his senior debut in 2015. He departed for Sassuolo later that year where he made over 50 appearances across all competitions before returning to Roma in July 2017.