The Italian news agency ANSA said the bodies of a 4- year-old boy, his parents and his grandfather were found in the flooded basement of their two-family home. Before dying, the grandfather managed to save the boy's sister, state TV RaiNews24 reported.
Leghorn province's interior ministry official, Anna Maria Manzone, told Sky TG24 TV that by late afternoon two people were still missing.
"The city is literally devastated," said Leghorn Mayor Filippo Nogarin, adding that "a crazy amount of rain" pummeled the area in just a few hours.
Strong winds toppled trees and parked cars were nearly submerged by floodwaters that also left streets clogged with mud.
Nogarin appealed for volunteers to help. The city has a population of 1,70,000 and is a popular spot for travelers catching ferries to the islands of Elba and Sardinia.
Train service was interrupted in parts of the Tuscan coastal area along the Tyrrhenian Sea.
City Hall urged residents and visitors to go outside only for urgent reasons and to avoid parks after morning thunderstorms lashed Rome.
Possible hailstorms and strong winds were predicted throughout the rest of today and tomorrow.
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