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Objectives Brachial radiculoplexitis is a rare inflammatory neuropathy, often secondary to viral infections such as Herpes Zoster. We describe an atypical case of herpetic brachial radiculoplexitis with concomitant phrenic nerve involvement.Summary A 68-year-old female presented with a 2-week history of exertional dyspnoea in the context of a 4-week history of cutaneous herpes zoster which had been treated with oral Valaciclovir. Incidentally, she was identified to have right upper limb weakness. Upper limb examination showed diffuse right sided weakness, predominantly affecting the shoulder and elbow with 1/5 power. Reflexes were reduced with no sensory involvement. This was accompanied by a C3/4 dermatomal rash on the upper right shoulder/trapezius.MRI Brachial Plexus revealed thickening, STIR hyperintensity and enhancement in the right brachial plexus extending from C5 to T1, with enhancement and oedema in proximal shoulder muscles. Electromyography corroborated this with evidence of upper and middle brachial plexus trunk denervation including fibrillations, positive waves and large motor units. Notably, her chest X-ray revealed a raised right hemidiaphragm, causing a severe restrictive pattern on spirometry.Conclusion The unifying diagnosis for her dyspnoea and weakness was ultimately herpetic brachial radiculoplexitis with concomitant phrenic nerve involvement. The involvement of the C5 nerve root resulted in concurrent brachial plexus and phrenic nerves palsies. The patient was treated with supportive care, having completed a course of antivirals. On follow up, she has ongoing proximal weakness in the shoulder and elbow confining her to a sling but shows improvement in her dyspnoea and distal weakness.