We report a 57-year-old man with falciparum malaria contracted in Kenya who presented with a three-day history of symptoms. Despite prompt treatment with quinine and artesunate and rapid clearing of the parasitaemia, he developed multiple complications and died 28 days after presentation. This case illustrates the potential for malaria to be fatal despite appropriate treatment and is one of the first reports of the use of artesunate in a hospital in a developed country.