Rivaroxaban-Associated Bullous Pemphigoid in a Patient With Atrial Fibrillation

Rivaroxaban is commonly used for prevention of thromboembolic diseases in patients with atrial fibrillation. We report a case of an 86-year-old man with hypertension, chronic kidney disease, type 2 diabetes mellitus, dyslipidemia, and atrial fibrillation who developed bullous eruptions 1 week after a rivaroxaban dose increase. He was subsequently hospitalized, and direct immunofluorescence confirmed bullous pemphigoid (BP). After switching to apixaban, the patient's skin eruptions stabilized and improved. This is the first reported case of immunofluorescence-confirmed BP associated with rivaroxaban use. Prompt discontinuation of rivaroxaban and a switch to other anticoagulants is important for patients with suspected drug-associated BP.