Ethambutol is an oral anti-tuberculosis agent with chelating effects owing to its chemical structure which is similar to that of penicillamine. Copper (Cu) is an essential trace element that has important roles in physiological function of the body organs. The aim of present study was to determine (1) whether ethambutol usage can alter serum Cu concentration in patients with tuberculosis and (2) whether there is any relationship between age, sex, and smoking habit of patients with changes in serum Cu levels. Sixty patients with diagnosis of pulmonary tuberculosis were enrolled the study. Blood samples were obtained before treatment (baseline) and 10 days after starting anti-tuberculosis therapy. The amounts of serum Cu were determined in all samples by atomic absorption. Mean +/- SD levels of Cu at baseline and on the 10th day of ethambutol use were 0.94 +/- 0.24 and 0.64 +/- 0.24 microg/mL, respectively. Statistical analysis confirmed a significant difference (p < 0.0001). Also, there was not any relationship between changes in Cu concentration and study variables of age, sex, and smoking habit. Our findings endorse the chelating effect of ethambutol leading to a decrease in serum levels of cationic trace elements, e.g., Cu.