A previously healthy 62-year-old woman presented to our clinic after a two-day stay in Equatorial Guinea. Her symptoms included fevers, fatigue and headache. Diagnostics revealed a complicated falciparum malaria. During the course of her antimalaria treatment she developed acral necrosis on all of her extremities, likely because of impaired microcirculation. It is a rare complication of a severe malaria infection captured in these images.