A 64-year-old man suffered from progressive swallowing difficulty, in particular of solid food. There was a feeling of food getting stuck. He needed to take small bites and coughed while he was eating. Choking occurred frequently, and sometimes food came out his nose. He lost 7 kg over the past year. Gradually, drinking also became difficult. His GP first referred him to an ENT specialist and subsequently to a gastroenterologist who referred him to a neuromuscular centre. He was treated with Botox injections in the cricopharyngeal muscle, and this ameliorated his swallowing problems for about a year. He did not complain about limb weakness, diplopia, drooping eyelids, slurring of speech, shortness of breath, or muscle twitching. Family history was unremarkable.