Anti-immunoglobulin-like cell adhesion molecule 5 (IGLON5), a disease first described in 2014 by Sabater et al., is characterised by dysphonia, dysphagia, stridor and dysautonomia. We discuss the case of a patient presenting to the emergency department with anti-IGLON5 associated airway compromise following progressive reduced vocal cord movement requiring a surgical tracheostomy. We discuss the outpatient and emergency presentation of this case along with the available literature on anti-IGLON5. We aim to remind ENT practitioners to look beyond the common diagnoses and consider the diagnosis of anti-IGLON5 disease when faced with the symptoms listed above.