Vitamin K deficiency Quiz: Ace Your Exams

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A 31-year-old man comes to the office for the evaluation of bleeding from the gums and easy bruising. The patient reports that even minor trauma causes a bruise, and he sometimes bleeds spontaneously from his gums. He also complains of frequent fatigue, generalized weakness, and poor appetite. Past medical history is significant for Crohn disease that required a partial small bowel resection a year ago. The patient has also been receiving oral antibiotic treatment for a perianal fistula for the past 3 months. Family history is noncontributory. Vitals are within normal limits. Physical examination shows multiple large ecchymoses of the lower extremities and trace bleeding from the gums. Laboratory results are shown.  

Which of the following is the most likely cause of this patient’s presentation?  

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