CASE PRESENTATION: 72-year-old former smoker woman presented with shortness of breath, wheezing, cough, and fever. She had a recent ICU admission for COPD exacerbation, and was discharged a few days prior to the current presentation. On exam she was febrile, and had diffuse expiratory wheezing. Laboratory work up was significant for leukocytosis. Chest imaging revealed hyperaeration of lungs. Patient was treated with NIPPV, steroids, antibiotics, and bronchodilators. Dyspnea resolved, but mild expiratory wheezing persisted. On day 12, patient was evaluated for poor food intake, and examination revealed oral thrush that was attributed to inhaled steroids. ENT evaluation was called to assess the extent of thrush in the larynx. Bedside fiberoptic laryngoscopy revealed immobile right vocal fold with narrowed pinpoint airway, owing to large obstructive submucosal laryngeal mass. Emergent awake tracheotomy was performed to protect the airway, with subsequent direct laryngoscopy. Biopsy showed poorly differentiated squamous cell carcinoma. Ultimately, total pharyngo-laryngectomy was performed. Patient was deemed to have T4aN2bM0 subglottic squamous cell carcinoma.