Background: Patients with rheumatic diseases have an increasing risk of opportunistic infections, particularly tuberculosis(TB). The aim of this study is to elucidate the diagnostic and treatment problems of pulmonary TB developing in patients with rheumatic diseases. Methods: The medical records of all patients with rheumatic disease and concurrent newly active pulmonary TB, seen at Hanyang university hospital between January 2009 and December 2011, were reviewed retrospectively. Two times the number of age- and sex-matched control subjects were randomly selected from among the patients with pulmonary TB, newly diagnosed and treated during the same period. Results: Of 32 patients who enrolled, rheumatoid arthritis (RA) was 22 (68.6%). Diagnosis of active pulmonary TB in rheumatic disease was more frequently based on radiology and clinical feature, than control (43.8% vs. 20.3%, p=0.016). Asymptomatic patients were more frequent in rheumatic disease (37.5% vs. 18.8%, p=0.042). Positivity of sputum acid fast bacilli and culture in rheumatic disease were lower than control, significantly. There was no significant difference between two groups in maintenance of 1st line anti-TB medication. However, change of anti-TB medication due to severe adverse drug reaction was more frequent in rheumatic disease. Conclusion: The majority of patients with rheumatic disease and concurrent active pulmonary TB had less symptomatic and more frequent severe adverse drug reaction. Therefore, we need to support the continued screening of rheumatic disease with active pulmonary TB.