The aim of this case report is to elucidate the unusual presentations and outcomes of sudden onset of pre-eclampsia with severe features and massive progressive painful bilateral pedal oedema up to the groin and vulva in an unbooked 23-year-old primigravida. The blood pressure was significantly elevated (170/130 mmHg) on presentation with associated significant proteinuria (+++) and elevated serum creatinine. Obstetric scan done on presentation confirmed a live active intrauterine fetus at 26 weeks of gestation. She was managed conservatively with antihypertensive and was delivered of a live male neonate with good Apgar scores following induction of labour at 28 weeks of gestation. Both mother and baby were discharged home in good conditions.