We report a patient with ankylosing spondylitis presenting dysphagia as a chief complaint. A 43-year-old man complained of swallowing difficulty persisted for a year. Laryngoscopy revealed bilateral arytenoid swelling. Videofluoroscopic swallowing study (VFSS) revealed penetration and aspiration of liquid, food residue in pyriform sinuses, multiple swallowing and passage disturbance of food. C-reactive protein and erythrocyte sedimentation rate were elevated. On physical examination, neck stiffness and limitation of motion of whole spine were shown. Simple radiography of spine and sacroiliac joints displayed cervical osteophyte, bamboo spine and bilateral sacroilitis. Bath ankylosing spondylitis disease activity index was 6.3 points. He was diagnosed as severe active ankylosing spondylitis. After the conservative treatment, range of motion of whole spine increased and dysphagia improved on follow-up VFSS. Dysphagia in ankylosing spondylitis may be attributed to postural changes due to limitation of cervical motion and inflammation of soft tissue. (J Korean Acad Rehab Med 2009; 33: 489-492)