Occurrence of monoarthritis or oligoarthritis during the course of zoster is exceedingly rare (three previously reported cases). In the additional case reported herein, an immunocompetent female exhibited oligoarthritis (right shoulder followed by two metacarpophalangeal joints in her right hand) a few days before developing a typical zoster eruption in the ipsilateral upper limb. Pathogenesis of zoster-related arthritis is discussed. The most likely hypothesis is infection of the joint via the nerve supply rather than via the bloodstream. Evidence in support of this mechanism includes recovery of the virus from synovial fluid specimens in a previously published case.
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