Hematogenous osteomyelitis is a known complication of varicella. Osteomyelitis accompanying adjacent soft tissue infection, however, has only been described once in the literature. We report 2 cases of metacarpal osteomyelitis complicating varicella-associated cellulitis of the hand. The cases illustrate that this diagnosis should be considered in a patient with varicella, soft tissue infection and lack of clinical improvement despite apparently appropriate therapy.