Fusobacterium nucleatum is a gram-negative bacillius commonly found in 
oropharynx and is traditionally associated with Lemierre syndrome, which is 
characterized by history of recent oropharyngeal infection, internal jugular 
vein thrombosis, and isolation of anaerobic pathogens, mainly Fuosobacterium 
necrophorum. However, recent evidence indicated that F. nucleatum is also a 
normal resident of human gut. Less than a dozen of case reports had linked F. 
nucleatum to gastrointestinal variant of Lemierre syndrome with portal vein 
thrombosis. However, F. nucleatum bacteremia-associated hepatic vein thrombosis 
is very rare. We report a case of a 73-year-old man who had hepatic vein 
thrombosis associated with F. nucleatum bacteremia, most likely from subclinical 
primary infection affecting the lower gastrointestinal tract. The underlying 
pathophysiology and treatment options are discussed here. With rapid increase in 
reporting of Lemierre syndrome, this case deserves particular attention from 
clinicians.