Lemierre syndrome, also known as necrobacillosis or postanginal septicemia, received its name from a comprehensive clinical description by Lemierre in 1936. The syndrome usually follows an acute oropharyngeal infection caused by F necrophorum (a constituent of normal flora) and secondary thrombophlebitis of the internal jugular vein and metastatic infection.1 The illness occurs in previously healthy adolescents or young adults, starting with pharyngeal or tonsillar inflammation2 and followed by recurrent fevers. The presence of jugular venous thrombophlebitis is considered a hallmark of the illness, though is not always present. Metastatic sequelae include pneumonia, pleural effusions, lung nodules and infarctions, septic arthritis, soft tissue abscesses, cellulitis, osteomyelitis, liver abscess, endocarditis, and meningitis.3 Thrombocytopenia and leukocytosis are present, and hepatic enzyme abnormalities with hyperbilirubinemia often are present.4 The organism is isolated from blood or other infected sites in anaerobic cultures. Lemierre syndrome is primarily a clinical diagnosis,5 although CT and ultrasound findings are sensitive in confirming the diagnosis.6 Recommendations for treatment include prolonged antibiotic therapy. Susceptibility testing to penicillin is important because of possible β-lactamase production.7 Invasive interventions are indicated to drain the purulent fluid collections.