Isolated uvulitis is a rare but potentially devastating condition that can result in airway compromise. Etiologies include infection, trauma, allergy, primary angioedema, immunologic disorders, and inhalation injury. Uvulitis has been previously reported as a reaction to inhalation of cannabis, crack cocaine, and mephedrone. We present a case of isolated uvulitis with concerns for impending airway obstruction in a patient after smoking fentanyl. While a sore throat is a common chief complaint among ED patients, emergency providers should consider uvulitis within this deadly differential.