Globally, malaria is the most important parasitic disease, representing a public health problem in more than 90 countries. In recent years, there has been an increased incidence of respiratory complications. Acute respiratory distress syndrome is the most severe form of the respiratory complications of malaria, with high mortality despite adequate therapeutic management. This syndrome is characterized by severe dyspnea, cough and refractory hypoxemia. Early ventilator and hemodynamic support with the execution of parenteral antimalarial treatment are key components of management. Therefore, the presence of dyspnea in malaria patient should alert physicians, as the development of respiratory distress is a poor prognostic factor.