Background: tuberculosis (TB) is a multisystem disease with myriad presentations and manifestations that may be pulmonary or extra-pulmonary. It is the most common cause of infectious diseases related mortality worldwide. Mechanisms underlying host defense to TB infection are poorly understood. Adiponectin is a protein produced exclusively in adipose tissue; it is lower in obese subjects than their lean counterparts. Another adipocyte hormone is leptin which is higher with fat mass and body mass index (BMI). Wasting is a known feature of TB with a decrease in BMI. Patients with pulmonary TB disease often suffer from weight loss and BMI and leptin are known to be inversely correlated with adiponectin. Thus, increased adiponectin may be a promising marker for severity of the disease independent of the BMI and leptin. Aims of the work: the work aimed to evaluate the levels of serum adiponectin in patients with pulmonary TB in both active and latent TB patients as a diagnostic marker for tuberculous inflammation. Also, levels of serum leptin and measured BMI were evaluated and compared to make a relationship among active TB, latent TB, and healthy control groups. Subjects and Methods: the subjects were divided into 3 equal groups. The 1^st group included 25 patients with active pulmonary TB. The 2^nd group included 25 patients with latent TB after 6 months of diagnosis. The 3^rd group included 25 healthy control volunteers. Serum levels of adiponectin and leptin were measured and BMI values were calculated to all groups. Results: Serum adiponectin levels in patients with active pulmonary TB were very highly significantly increased compared to both latent TB patients and healthy subjects (P<0.0001), while serum adiponectin levels in patients with latent pulmonary TB were only significantly increased compared to the healthy subjects (P<0.05). On the other hand, serum leptin levels in patients with active pulmonary TB were very highly significantly decreased compared to both latent TB patients and healthy subjects (P<0.0001), while serum leptin levels in patients with latent pulmonary TB were only significantly decreased compared to the healthy subjects (P<0.05). Also, BMI in patients with active pulmonary TB were very highly significantly decreased compared to both latent TB patients and healthy subjects (P<0.001), while BMI in patients with latent pulmonary TB were only significantly decreased compared to the healthy subjects (P<0.05). Conclusion: the higher levels of adiponectin with lower levels of leptin in association with lower BMI measurements might indicate activity and severity of the TB disease. On the other hand, the lower levels of adiponectin with higher levels of leptin in association with higher BMI measurements might indicate stability and latency of the TB disease. Thus, increased adiponectin in the serum of pulmonary TB patients may be promising markers for severity of the disease independent of the BMI and leptin levels.