Just a fortnight after Claudio Ranieri's team had rescued a point at Craven Cottage thanks to Marco Andreolli's stoppage-time equaliser, the Serie A side once again had to battle back after going behind.
After a very lively opening, Fulham created the first chance in the eighth minute when Paul Konchesky found Bjorn Helge Riise, but the Norwegian's shot was blocked by Philippe Mexes.
Clint Dempsey's 20-yard effort was saved by Roma goalkeeper Alexander Doni before the Cottagers took the lead in the 19th minute.
Andreolli blatantly tripped Diomansy Kamara inside the area and the former West Brom star slotted home the resulting penalty himself.
Five minutes later Roma almost equalised when Mexes' header from Cicinho's cross flew narrowly wide before Juan Pablo Baptista also fired off-target.
Kamara almost doubled Fulham's lead before the break when his header from Konchesky's cross flew wide but the visitors deserved their narrow advantage at the interval.
The match was turned on its head though when Erik Nevland was sent off early in the second half.
He had only been on the pitch for three minutes after coming on as a half-time substitute for Kamara when he was shown a red card for a late tackle on Daniele de Rossi.
After Rodrigo Taddei had fired a fierce drive over the crossbar, and Mark Schwarzer had made a superb save to keep Stefano Guperti's left-footed strike out, Roma finally found the net in the 69th minute when John Arne Riise's left-footed strike from the edge of the area was deflected past former Middlesbrough keeper Schwarzer by Zoltan Gera.
Ranieri's side grabbed a deserved winner seven minutes later when Stefano Chuka Okaka headed home Taddei's right-wing cross and, to add insult to injury, Fulham were reduced to nine men in stoppage time when Konchesky was dismissed for an ill-judged challenge on Taddei.