Vitamin K deficiency: This is likely due to the patient's history of liver cirrhosis, which can lead to impaired vitamin K absorption and subsequent coagulopathy, manifesting as easy bruising or bleeding, including punctate bleeding lesions.

Thrombocytopenia: Liver cirrhosis can lead to splenic sequestration and subsequent thrombocytopenia, which may cause punctate bleeding lesions.
Vascular fragility: This could be due to various factors, including liver disease affecting collagen synthesis or steroid use, which can lead to fragile blood vessels prone to rupture.
Coagulopathy of liver disease: Apart from vitamin K deficiency, liver disease can affect the production of other coagulation factors, leading to a coagulopathy that might present with bleeding lesions.

Vasculitis: Although less common, vasculitis (inflammation of the blood vessels) can cause bleeding lesions and must be considered to avoid missing a potentially treatable condition.
Malignancy: Certain malignancies can cause coagulopathy or vascular abnormalities leading to bleeding lesions. It's crucial to rule out malignancy, especially in patients with a history of liver cirrhosis, which itself is a risk factor for hepatocellular carcinoma.
Infectious diseases: Endocarditis or other severe infections can cause bleeding lesions (e.g., Janeway lesions in endocarditis) and are critical not to miss due to their high morbidity and mortality if untreated.

Ehlers-Danlos syndrome: A genetic disorder affecting collagen synthesis, leading to highly fragile skin and blood vessels, which could present with spontaneous bleeding lesions.
Scurvy: Vitamin C deficiency can lead to impaired collagen synthesis, causing blood vessel fragility and potentially punctate bleeding lesions, although this is rare in the context provided.
Amyloidosis: A condition characterized by the deposition of amyloid proteins in various tissues, including blood vessels, which can lead to vascular fragility and bleeding.