Tumor necrosis factor-α (TNF-α) inhibitors are increasingly used in treatment of inflammatory disorders because of their immunomodulatory efficacy. Increased risk of infection is an adverse effect of anti-TNF-α therapy. The incidence rate and severity of herpes zoster is significantly higher in patients on anti-TNF-α therapy than in the general population. The clinical presentation of varicella zoster virus infection is also often atypical in these patients. We experienced a patient who presented with a disseminated varicelliform rash while on etanercept therapy for ankylosing spondylitis. (J Rheum Dis 2015;22:186-189)