DF and DHF were first documented in Malaysia in 1902 and 1962, respectively. A major dengue epidemic was recorded in 1973, and since then dengue has become endemic in Malaysia with major outbreaks occurring every 3–4 years. There were a number of reports describing the clinical features and risk factors associated with the severe manifestations of dengue and dengue-related deaths during the first two decades following the 1973 epidemic. During this period, children were the most predominant group affected, hence contributed substantially to the clinical description of severe dengue. In the last two decades, however, the number of dengue cases had escalated exponentially. There were 48,846 cases and 98 deaths in 2007 in Malaysia with those aged 15–35 years old contributing to at least 48% of the total number of dengue cases. The trend of higher percentage of adults contracting dengue has also been reported in other dengue endemic countries. This review of fatal cases of dengue infection was undertaken in light of this changing epidemiology of dengue in Malaysia and in this region.