The medical records of 4 cases of imported coronavirus disease 2019 (COVID-19) complicated with severe falciparum malaria diagnosed in Kunming Third People's Hospital in August 2022 were collected. The epidemiology, clinical manifestations, laboratory and imaging examinations, course of treatment and prognosis of 4 cases were analysed retrospectively. All the 4 cases were male, aged 40-54 years, and had a history of work and life in Africa. All cases had acute onset of symptoms, including fever (4 cases), chills (3 cases), shivering (3 cases), nausea and vomiting (3 cases), diarrhea (4 cases), and poor appetite (4 cases) as the main clinical manifestations. Headache, dizziness, unclear consciousness were reported in 2 cases, urinary incontinence in 1 case, muscle soreness in 2 cases, cough in 2 cases, phlegm in 1 case, and pharyngalgia in 1 case. All cases were positive for coronavirus. Nucleic acid test by throat swabs, and Plasmodium falciparum was found by microscopy examination of peripheral blood smear. All cases met the diagnostic criteria for severe malaria and were accompanied by abnormal liver function and severe hypoproteinemia, 2 cases of hyperbilirubinemia, 3 cases of dyslipidemia, 3 cases of abnormal blood picture involving the third system, increased calcitonin to varying degrees, 2 cases of lactic acid acidosis, and 1 case of hypoglycemia. Chest CT showed changes of viral pneumonia in 1 case. Antiviral drug and artesunate (intravenous injection 120 mg/time, once at 0, 12 and 24 hours, and once a day later for 7 consecutive days) were given, and different schemes of precise treatment were given based on the condition of the patient. All the patients were cured and discharged, and the follow-up was stable. It is suggested that the awareness of COVID-19 and malaria co-prevention should be established among the entry personnel in the high malaria epidemic areas abroad, to avoid serious cases and deaths.