Tuberculosis being a highly contagious chronic pulmonary and systemic disease is explicit cause of morbidity and mortality worldwide. There is a direct relationship between zinc and copper in maturation of immunity, Cu/Zn ratio in serum serves to assess levels of oxidative stress in infectious diseases and thus could be used as a diagnostic tool in early diagnosis of smear negative tuberculosis. To study and evaluate significance of serum Cu and Zn concentration and Cu/Zn ratio in smear negative pulmonary tuberculosis patients in comparison to apparently healthy controls. Observational case control study was carried out on patients attending IPD and OPD, Department of Pulmonary Medicine, RMCH. Fifty cases of smear negative PTB patients(group A) was taken and compared with fifty age and sex matched apparently healthy controls(group B). Serum Cu and Zn were estimated in both groups by colorimetric method using EM Chem5Plus V2 Semi autoanalyzer. Data is presented as mean ± SD. Comparison of serum levels of the parameters between the two groups was performed by Student’s‘t’ test. The p value <0.05 was considered as statistically significant. We found serum Zinc to be significantly lower in group I than group II(p<0.00), serum Copper & Cu/Zn ratio to be significantly higher in group I than II(p<0.00). The results suggests that early estimation of serum Cu, Zn & Cu/Zn ratio serves as useful diagnostic marker for smear negative pulmonary TB cases though more extensive multicentric study will provide more insights.