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This 72 year old man developed an ache in his shoulder after his second infusion of infliximab (3 mg/kg) for his rheumatoid arthritis. By the next day vesicles had developed in the T3 dermatome. He visited his general practitioner who prescribed aciclovir but unfortunately he did not take it as he worried about aciclovir interacting with his other medications. Two days later he visited the rheumatology department with a severe herpes zoster rash (fig 1). With increased prescribing of biological therapy, severe forms of herpes zoster rashes are going to become much more common.