Malignant Post-Vietnam Stress Syndrome describes a severe form of combat-related posttraumatic stress disorder. We update the concept of Malignant Post-Vietnam Stress Syndrome, considering the effects of repeated severe traumatization, exposure to atrocities, and a variety of comorbid conditions. An illustrative case report demonstrates an interdisciplinary treatment approach, combining case management, brief hospitalizations, symptom-directed use of medications, and supportive psychotherapy.