Context: Complicated Plasmodium falciparum Malaria is a syndrome and a disease of protean, clinical manifestations including jaundice, ARF, ARDS and multi-organ failure. Aims: The objectives of the present study are to study clinical features, complications and factors affecting outcome of patients with complicated P. falciparum Malaria. Settings and Design: This retrospective descriptive study was conducted at tertiary care centre in western Maharashtra from January 2010 to December 2010. Methods and Material: Total 73 patients with complicated P. falciparum malaria who presented with fever having positive trophozoites of P. falciparum in blood smear were included. SPSS (version-10) software was used for all statistical calculations. Results: A total 73 patients had complicated P. falciparum malaria with 52 were males and 21 were female patients. Total 9 (12.32 %) patients were presented with shock as a presenting feature. Four (5.47 %) patients had hypoglycaemia at the time of admission. Total 43 (58.90 %) patients had jaundice, 37 (50.68 %) had anaemia, 28 (38.35 %) had cerebral malaria, 7 (9.58 %) had acute renal failure, 5 (6.84 %) had ARDS and 5 (6.84 %) had thrombocytopenia. Total 46 patients had single complication in the form of cerebral malaria 14 (19.17 %), jaundice 15 (20.54 %) and anaemia 16 (21.91 %). Total 14 patients had two complications in the form of jaundice with ARF 02 (2.73 %) with one (50 %) death and jaundice with anaemia 12 (16.43 %). Total 9 (12.32 %) patients had three complications in the form of cerebral malaria with jaundice with anaemia with 3 deaths (33.33 %). Total 5 (6.84 %) patients had multiple complications in the form of cerebral malaria with ARF with ARDS with thrombocytopenia with 4 (80 %) death. Case fatality rate was 10.95 %. The case fatality rate with ARDS was 80 % (4/5), with ARF was 57.14 % (4/7) and with cerebral malaria it was 25 % (7/28). Case fatality rate was highest in patients with pulmonary complication (ARDS) compared to ARF, cerebral malaria, jaundice and anaemia with ‘p’ < 0.001. Conclusions: Acute renal failure and ARDS were least common presentation with poor outcome. In present study most common presentation was with jaundice and anaemia next to that was cerebral malaria. The case fatality rate of P. falciparum malaria was 10.95 %. Overall case fatality rate was highest with multi-organ dysfunction (80 %). Unusual early renal and pulmonary complications were the presenting features of complicated P. falciparum malaria were observed in present study. Presenting feature as a shock was invariably associated with either ARDS or ARF with high mortality. This study highlights the burden of complicated malaria including multi-organ dysfunction in western Maharashtra.