Aquatic macroinvertebrates are a primary component of freshwater ecosystems and one of the most threatened by anthropogenic pressures. Among them, dragonflies are a charismatic group of growing scientific and social interest. However, little is known about the natural history of several species. One paradigmatic example is the declining Orthetrum nitidinerve, a Western Mediterranean endemic anisopteran. We reviewed published and new data on this species, addressing distribution, autecology, and conservation (with a focus on Italy), and provide its first genetic characterization and phylogenetic placement within the genus. In Italy, the species is known from 50 sites so far (only 17 breeding populations) located in Sardinia and Sicily (1841-2019, only 22 from 1990 onward). Records from continental Italy are due to misidentification. The flight period in Italy spans between May and September. Habitat consists of permanent freshwater (mostly helocrene sources, seepages, and small brooks), slow-flowing, shallow, with muddy bottom deposits at elevation from the sea level up to 1000 m asl. All the breeding populations are found in open and sunny landscapes, almost invariably in extensive pasturelands. The species has strongly declined in Sicily, whereas several large populations still occur in Sardinia. The major threats identified so far are agriculture and grazing intensification or abandonment and drought/source desiccation determined by water overexploitation and climate change. The first ever provided mitochondrial COI barcode and ITS nuclear sequences allowed a first tentative phylogenetic placement of the species as a sister group of the O. brunneum/O. lineostigma lineage.