ABSTRACT
Malaria is still the most prevalent and devastating parasitic disease worldwide. In recent years drug resistance Plasmodium falciparum malaria has returned to most of the tropical countries of the globe with a vengeance. Due to various atypical manifestations the diagnosis has become confusing and hence the treatment delayed leading to various complications and increased mortality and morbidity. Patient presents with features of severe complicated malaria with multiorgan involvement in the form of malarial crisis needs emergency management in ICU. All fever cases with possible malaria should be investigated and to be treated with intravenous quinine/artimisinine pending confirmation of diagnosis. Any emergency situation that develops during treatment should be treated aggressively as medical emergency.