A 29-year-old woman comes to the physician because of a 1-year history of skin bruising. She has no trauma and sometimes has spontaneous bruising over her legs. The patient has a history of Crohn disease that required a partial bowel resection a year ago. Three months ago, she was treated with oral antibiotics for a perianal fistula. Her mother died of colon cancer when she was 56. Physical examination shows several large ecchymoses on her lower extremities. Which of the following is the most likely diagnosis?

Question

A 29-year-old woman comes to the physician because of a 1-year history of skin bruising. She has no trauma and sometimes has spontaneous bruising over her legs. The patient has a history of Crohn disease that required a partial bowel resection a year ago.  Three months ago, she was treated with oral antibiotics for a perianal fistula.  Her mother died of colon cancer when she was 56.  Physical examination shows several large ecchymoses on her lower extremities.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

Eductional Objective: Crohn disease with ileal resection or extensive ileal involvement can cause bile acid malabsorption, which may lead to impaired absorption of fat-soluble vitamins (A, D, E, K).  Vitamin K deficiency can result in impaired coagulation with easy bruising, large hematoma formation in deep tissues and joints (eg, hemarthrosis) after minor trauma, and prolonged bleeding after surgery.

A 29-Year-Old Woman Comes to the Physician Because of a 1-Year