At the start of the 21st century, the Italian Army's self-propelled artillery brigade primarily consisted of the ageing M109L SPH, and therefore a decision was made to procure a replacement. On 17 December 2002, a consortium led by OTO Melara signed a contract with the German company KMW for a licence to produce 70 Panzerhaubitze 2000s for the Italian Army. The vehicle was produced locally and delivered between 2004–2008. Six of the vehicles were later donated to Ukraine in 2022, leaving 64 in service with the Italian Army as of 2026.

Introduced in Update 2.59 "Sky Odyssey", the Italian PzH 2000 has a high rate of fire for a 155 mm gun, excellent ballistics, a laser rangefinder, and automatic loading. These features make it highly effective at medium and long ranges, while its mobile chassis allows it to reach required positions quickly. The vehicle's drawbacks include its relatively low level of protection, large size, and slow horizontal aiming.