Low plasma vitamin A levels (mean, 18.1 +/- 10.3 micrograms/dl, 62% below normal) were demonstrated in South African children with pulmonary tuberculosis. More extensive or severe disease (e.g., additional extrapulmonary tuberculosis) and low levels of retinol binding protein, prealbumin, and albumin were associated with low vitamin A levels. High-dose vitamin A therapy had no effect on disease outcome.