Introduction

Lemierre's syndrome, first described by André Lemierre in 1936, is classically defined by oropharyngeal sepsis, internal jugular vein thrombophlebitis, and hematogenous dissemination of anaerobic organisms, predominantly Fusobacterium necrophorum, to distant organs. The lungs are the most frequent site of metastatic seeding, with pulmonary infarctions and cavitating nodules representing characteristic findings [1, 2]. Despite its severity, the syndrome remains underrecognized due to its rarity, and the prototypical presentation in young adults can be mistaken for uncomplicated pharyngitis before systemic deterioration occurs [2, 3].

Conceptually, however, the syndrome is better understood as a pathophysiologic triad rather than an anatomic one: a primary focus of anaerobic infection, contiguous septic thrombophlebitis of the draining vein, and downstream metastatic septic embolization from that infected thrombus. It is this sequence, rather than the oropharyngeal site of origin per se, that defines the entity. The visceral (abdominal) variant of Lemierre's syndrome, in which the primary infectious focus resides within the abdomen or pelvis rather than the oropharynx, has been reported only in isolated case series and small case reports [4, 5]. In these atypical cases, the portal, mesenteric, or hepatic venous system assumes the role of the internal jugular vein as the conduit for septic thrombophlebitis and downstream embolic seeding [5]. Because the oropharyngeal hallmark is absent by definition in this variant, diagnosis is frequently delayed and anaerobic bacteremia underappreciated. We report this case to expand clinician awareness of the visceral variant of Lemierre's syndrome and to highlight key diagnostic and management considerations.