Varicella-associated Arthritis Occurring Before the Exanthem

Varicella-associated arthritis represents an uncommon complication of varicella in children. In 20 previously reported cases, three were documented to be bacterial in origin. Viral isolation from synovial fluid was attempted in seven others, and varicella was isolated in just two. In all previous case reports, the arthritis occurred after or coincident with the onset of varicella. The current case is one in which joint involvement preceded the clinical onset of varicella. Clinicians should be alert to the possibility that varicella may manifest as an acute arthritis, even in the absence of the typical exanthem.