Abstract Background: Severe malaria remains a leading cause of morbidity and mortality worldwide, particularly among vulnerable populations such as the elderly and individuals with comorbidities. The interaction between malaria, dehydration, hypertension, and stroke can accelerate multiorgan dysfunction through complex hematological, haemostatic, and microvascular mechanisms. Case Presentation: We report the case of an 85-year-old hypertensive female with preexisting asthma and arthritis who developed acute febrile illness, inability to swallow, and severe dehydration. She subsequently suffered acute stroke, presented unconscious, and was diagnosed with severe Plasmodium falciparum malaria and dehydration. Despite treatment, she developed progressive multiorgan failure involving neurological, renal, hematological, haemostatic, and cardiovascular systems and died two days after hospitalization. Discussion: Severe malaria induces hemolysis, endothelial dysfunction, hypercoagulability, and microvascular obstruction, leading to cerebral ischemia, acute kidney injury, and systemic inflammatory response. Dehydration worsens hypovolemia, increases blood viscosity, and promotes thrombosis, especially in hypertensive elderly patients. Stroke further compromises neurological and systemic homeostasis. These processes culminate in multiorgan dysfunction syndrome and death. Conclusion: Severe malaria combined with dehydration and hypertension significantly increases risk of stroke and multiorgan failure in elderly patients. Early diagnosis, hydration, and aggressive management are essential to prevent fatal outcomes.