Background: Malaria is endemic and represents an important public health issue in India. Knowledge of risk factors for disease progression represents an important step in preventing and controlling malaria-related complications. Reports of severe forms of Plasmodium vivax malaria are now becoming a common place, but respiratory complications are described in less than 3% of global literature on severe vivax malaria.

Case presentation: A 59 years old female presented the chief complaints of shortness of breath, fever with chills, generalized weakness, Nausea and vomiting for 4 days. Patient had positive history of diabetes mellitus, hypertension and was on regular medication since 6 years. Investigations showed raised TLC (12,300), Rapid Malarial Antigen test was positive, Smear for malarial parasite was positive for plasmodium vivax schizonts. Pt was kept on NIV, was started on Antibiotics, Artesunate therapy and was managed symptomatically. Patient general condition was improved at the time of discharge.