BACKGROUND Following the detection of the first laboratory-confirmed Monkeypox (MPXV) infection in the Philippines, guidelines on Monkeypox diagnosis, treatment, and prevention have been strengthened to further help healthcare providers in differentiating it properly from other diseases with similar clinical presentation, one of which is Varicella zoster (VZV) infection. Interestingly, co-infection with Monkeypox and Varicella has been previously reported in Monkeypox endemic countries. We then report the first travel-related case of MPXV-VZV co-infection in the Philippines, a country that is endemic for Varicella but non-endemic for Monkeypox. CASE PRESENTATION A 29-year-old Filipino, female, with a travel history to Switzerland and with no prior history of VZV infection consulted due to rashes. She presented with multiple papular, pustular, and vesicular skin lesions, some with umbilication and with irregular borders, on the face, neck, trunk, inguinal area, upper extremities, and right leg. She also had bilateral submandibular and post-auricular lymphadenopathies. Tzanck smear exhibited viral cytopathic effects. She was confirmed to have Monkeypox infection from Clade II and Varicella infection via quantitative real-time polymerase chain reaction (qPCR) tests. Shotgun metagenomic sequencing (mNGS) successfully recovered sequences from the Varicella zoster virus which corroborated with the high viral load detected using qPCR. In contrast, shotgun mNGS showed too few reads mapped to the Monkeypox virus reference sequence. Systemic and topical acyclovir was given to the patient. She was discharged and continued home isolation for 30 days from the rash onset. CONCLUSION Strategies have been formed by the country’s healthcare facilities to properly identify monkeypox infection. However, Monkeypox co-infection with other viral diseases presented a challenge in the proper diagnosis of our patient. This prompted a high index of suspicion and the usage of suitable diagnostic tests. The qPCR tests confirmed the presence of both Monkeypox and Varicella zoster virus infections in the patient. Shotgun metagenomic sequencing (mNGS) successfully recovered sequences from the Varicella zoster virus, while there were too few reads mapped to the Monkeypox virus reference sequence. With proper clinical evaluation and utilization of appropriate diagnostic tests, we were able to diagnose the first Filipino patient with Monkeypox and Varicella zoster virus co-infection.