Severe vitamin K deficiency-associated coagulopathy triggered by Clostridioides difficile infection and antibiotic-associated dysbiosis: A case report and literature review

PURPOSE: Clostridioides difficile infection (CDI) represents a major healthcare associated infection with potentially life-threatening complications. While gastrointestinal and systemic manifestations are well recognized, severe micronutrient deficiencies, particularly vitamin K deficiency are rarely described. We aimed to report a unique case of CDI-and antibiotic-associated dysbiosis and malabsorption leading to profound vitamin K deficiency and coagulopathy, thereby highlighting the clinical intersection between infection, microbiome disruption, and hemostasis. METHODS: We report the clinical course, diagnostic work-up, and therapeutic management of an elderly female patient with CDI complicated by life-threatening coagulopathy. In addition, a narrative review of published case reports of antibiotic-associated vitamin K deficiency was performed to contextualize our findings. RESULTS: The patient developed extensive subcutaneous hematomas with a severely deranged coagulation profile (PT > 100 s, INR > 8, markedly reduced activities of vitamin K-dependent factors). Normal liver function and preserved platelet count excluded disseminated intravascular coagulation and hepatic failure. The findings were consistent with severe vitamin K deficiency secondary to antibiotic-induced dysbiosis, malnutrition, and persistent diarrhea. High-dose intravenous vitamin K supplementation resulted in rapid normalization of coagulation parameters within 24 h, with subsequent clinical stabilization and resolution of bleeding manifestations. CONCLUSION: This case illustrates a rare but clinically significant complication of CDI: profound vitamin K deficiency-associated coagulopathy. Clinicians should maintain a high index of suspicion for vitamin K deficiency in elderly, malnourished, and antibiotic-exposed patients with CDI who present with unexplained coagulopathy or bleeding.