Bacille Calmette-Guérin (BCG) lymphadenitis is the most common complication of BCG vaccination. Two forms of BCG lymphadenitis can be recognised in its natural course—simple or non-suppurative lymphadenitis, which usually regresses spontaneously over a period of few weeks, and suppurative BCG lymphadenitis distinguished by the development of fluctuations in the swelling, with erythema and oedema of overlying skin. Healing in suppurative glands occurs through spontaneous perforation and sinus formation, followed by closure of the sinus by cicatrisation. Non-suppurative BCG lymphadenitis is best managed with expectant follow ups only, because medical treatment with erythromycin or antituberculous drugs do not hasten the regression or prevent development of suppuration. Suppurative BCG lymphadenitis may be treated by needle aspiration to hasten resolution and prevent spontaneous perforation and sinus formation. Surgical excision is rarely needed and is meant for cases of failed needle aspiration or for draining BCG nodes.

Various treatments have been used to decrease the risk of suppuration; the most troublesome complication of Calmette-Guerin bacillus adenitis, but results are controversial. Metaanalysis of four randomized controlled trials revealed no significant difference in the frequency of suppuration between the treatment and control groups for all treatments [relative risk (RR), 1.10; 95% confidence interval (CI), 0.88 to 1.38], erythromycin (RR 1.04; 95% CI 0.79 to 1.37) and isoniazid (RR 1.35; 95% CI 0.84 to 2.18). Therefore medical treatment does not reduce the frequency of suppuration in Calmette-Guerin bacillus adenitis.

A 13-month-old boy presented with repeated episodes of tongue biting during sleep. On evaluation, he was found to have hereditary chin trembling, a rare autosomal dominant condition characterized by continuous or intermittent tremulous activity of the mentalis muscle. This is the first report of this kind from India. The tongue biting appeared to be the result of parasomnia. Treatment with clonazepam was very effective; it completely ameliorated the symptom of tongue biting but had no effect on chin trembling.

Breath-holding spells commonly occur during infancy. The disorder represents a self-limited, benign phenomenon, and breathholding spells almost always resolve by school age. Their continuing occurrence beyond this age is exceedingly uncommon and may create diagnostic confusion. We recently encountered an 8-year-old boy who continues to experience breath-holding spells.

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