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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