Introduction:Rituximab treatment increases the risk of developing severe COVID19 outcomes & is a deterring factor against potentially immunomodulating treatments such as pulse steroids and/or Tocilizumab.Aim:To present clinical experience from treatment modalities in patients on Rituximab sustaining severe COVID19 pneumonia and correlate with clinical outcome.Materials-Methods: Retrospective case series study of patients on Rituximab admitted due to COVID-19 pneumonia during 2022.Medical records & imaging case review.Results:During 2022, 6 patients on Rituximab were admitted to our Department due to severe Covid19 pneumonia and subsequent respiratory insufficiency. Mean age was 52 years, 4 females. All patients were on WHO 6 COVID-9 severity score.Mean hospital stay was 25days.Intubation occurred in 3/6 patients and 60d mortality was 16%(non covid19 death). Following a multidisciplinary team discussion on persisting clinical severity,3/6patients received pulse steroid treatment followed by stat dose Tocilizumab which managed to prevent intubation in 2/3 patients.No complication was noted by the administration of Tocilizumab and pulse steroids in these patients.Radiological improvement followed 72hours post both treatments which was followed by improvement in WHO COVID19 severity status.Conclusions:Tocilizumab and pulse steroid treatment is considered a contraindication in severely unwell COVID-19 patients on Rituximab.However, this limited case series demonstrates the combination of both can be used as salvage treatment in severely deteriorating COVID19 patients on Rituximab and prevents intubation in 67% cases.Our review continues in new cases and new data will be available soon.