The Coronavirus Disease 2019 (COVID-19) pandemic has placed a large demand on healthcare resources worldwide . Hydroxychloroquine is reported as an agent with potential benefit in prophylaxis and treatment and is being used for both . The authors hereby present the case of 63-year-old male patient with myasthenia gravis and 22-year-old female patient with mixed connective tissue disease, both on chronic therapy with hydroxychloroquine, who were admitted to intensive care with severe Acute Respiratory Distress Syndrome (ARDS) and COVID-19 infection . The patients had typical symptoms of fever, cough and dyspnea with lymphopenia on blood investigations . They were intubated and mechanically ventilated, requiring paralytics and proning, with subsequent dramatic improvement in oxygenation noted . This is the first report to describe the development of SARS-CoV-2 infection in patients already on hydroxychloroquine and demonstrates the need for robust clinical studies before we can recommend its use for routine prophylaxis in healthcare workers or exposed patient contacts.