A 70-year-old woman arrived at the emergency department presenting a seven-day worsening pruritic and painful rash.
No additional symptoms were present, including fever, arthralgia, anorexia, nausea, diarrhea, dyspnea, or other complaints.
Besides initiating dabigatran therapy four days before its appearance, there was no other epidemiological contexto or personal or family history of similar dermatological conditions.
The patient had a medical history of heart failure and had recently been diagnosed with permanent atrial fibrillation.
There was no history of allergies or drug reactions. Previous erythematous skin eruptions occurred in the past, affecting the trunk and back after taking apixaban and rivaroxaban. However, these were less severe and resolved only with drug withdrawal. Suspecting a cross-reaction between factor Xa inhibitors, her family doctor prescribed dabigatran (a thrombin inhibitor) as an alternative anticoagulant for atrial fibrillation.

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