PARIS (CNN) - An ailing Novak Djokovic exited the French Open to inspired underdog Marco Cecchinato on Tuesday in a thrilling encounter at Roland Garros.

The latest player to be hindered by injury at the French Open, Djokovic received a medical timeout for what appeared to be a neck or shoulder problem at the end of the first set, and fell 6-3 7-6 (7-3) 1-6 7-6 (13-11) to the 72nd-ranked Italian in nearly three and a half hours.

Cecchinato converted on his fourth match point in the gripping fourth-set tiebreak, his backhand return looping in as the Serb served and volleyed. Djokovic wasted three set points in the tiebreak and also couldn't serve out the set at 5-3.

The 12-time grand slam winner entered the French Open with momentum after an elbow injury and loss of motivation. When the dust settles, he might consider the fortnight to be a positive, yet he was the prohibitive favorite against Cecchinato.

Cecchinato, combining power, finesse and stellar movement, became the lowest-ranked men's semifinalist at the French Open since Andrei Medvedev in 1999. His "dream" continues, two years after being handed an 18-month ban for match fixing by Italy's tennis federation. The ban was later overturned.

"Am I dreaming? Maybe I'm sleeping," Cecchinato told the crowd. "I don't understand."

Cecchinato next faces Dominic Thiem, who beat second-seed Alexander Zverev 6-4 6-2 6-1. Zverev also received a medical timeout for a leg injury and was visibly hampered against the Austrian.

On Monday, Serena Williams withdrew from her high profile clash with Maria Sharapova due to a pectoral injury, and Lesia Tsurenko quit after two games of her encounter with Garbine Muguruza.

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