Pediatric emergency medicine trisk 2976 2976
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Gastrointestinal
perforation
May be silent
Abdominal
NPO, NG tube
(corticosteroids)
radiographs: flat Surgical consult
or associated
plate and upright
with abdominal
pain, distention,
vomiting
Calcinosis
Swelling
CBC
resembling
Radiograph
cellulitis around Aspiration
large joints
Fever
Antibiotics if
superinfection
suspected
Pain control
Carditis
Dyspnea,
tachycardia,
arrhythmias
Digoxin, diuretics
Antiarrhythmics
Corticosteroids
Chest radiograph
EKG
Echocardiogram
CBC, complete blood count; NPO, nothing by mouth; NG, nasogastric; EKG, electrocardiogram.
If pulmonary problems are suspected to result from infection, treatment with IV
antibiotics should be initiated after appropriate cultures are obtained. It should be noted
that patients with JDM may have persistent lymphopenia, especially those treated with
chronic or high-dose corticosteroids, that places them at risk for opportunistic
infections, like pneumocystis, for which prophylactic antibiotics are indicated. In
addition, sufficient corticosteroids (three times physiologic need) are given to
compensate for potential iatrogenic adrenal insufficiency if the child has recently
received high doses of steroids. Pneumothorax is another complication of JDM.
GI Complications. Vasculitic changes, characterized by intimal hyperplasia and
arteriolar occlusion by fibrin thrombi, are characteristic of severe or poorly controlled
JDM. Arteries and veins of the skin, muscles, and GI tract may be involved. Resultant
ulcerations and perforations may occur anywhere from the esophagus to the large
intestine, and they may disrupt the integrity of the integument. Symptoms and signs of
these complications depend on the site of the lesion. GI hemorrhage in JDM presents
similarly to GI bleeding from other causes, and its evaluation and management are
routine. The details of the management of hemorrhage from the GI tract are discussed
in Chapter 33 Gastrointestinal Bleeding .
In a patient with JDM, intestinal perforation may go unnoticed because of
corticosteroid therapy and may present with pneumatosis intestinalis. This finding also
may precede clinical perforation and pneumoperitoneum. Thus, any patient with JDM
and persistent abdominal pain should be examined radiographically for the presence of
gas in the bowel wall.
