The incidence of varicella zoster in adults is increasing, and may be associated with a number of significant complications. An adult male presented with varicella zoster complicated by pneumonitis and thrombosis, leading to a below-knee amputation. Thrombosis with varicella zoster has been associated with vasculitis and free protein S deficiency. Other microthrombotic complications, such as purpura fulminans, are more common in children. Current treatment recommendations include acetaminophen (paracetamol) and lotions for symptomatic treatment. Intravenous acyclovir is recommended in the treatment of complicated varicella zoster, although it has not been shown to reduce the incidence of complications.