The comprehensive review by Brigitte Pittet and colleagues on infection in breast implants briefly alluded to atypical mycobacteria as a cause of local infection.1 We would like to expand on the role of these pathogens in breast implant-related infections, as several outbreaks have been reported and routine microbiological methods will not detect these organisms, leading to delays in initiation of appropriate therapy.

Cases of active tuberculosis have been reported worldwide with the use of therapeutic agents that inhibit tumour necrosis factor (TNF) α. TNFα has a central role in mycobacterial infection and disease. Accordingly, progression of recently acquired tuberculosis infection or reactivation of remotely acquired infection should be expected with the use of anti-TNF agents. The available in-vitro and epidemiological evidence for the two currently approved agents, infliximab and etanercept, shows that the risk of development of active tuberculosis is greater with infliximab.