Fusobacterium necrophorum is a non-spore-forming, obligate anaerobic, 
filamentous, gramnegative bacillus that frequently colonizes the human oral 
cavity, respiratory tract, and gastrointestinal tract. Fusobacterium species 
have rarely been implicated in cases of gastrointestinal variant of Lemierre's 
syndrome. We describe a case of F. necrophorum bacteremia associated with 
suppurative porto-mesenteric vein thrombosis (PVT) following acute ruptured 
appendicitis. In addition, we list the documented twelve cases of Fusobacterium 
pylephlebitis. Recanalization of the porto-mesenteric veins and relief of the 
extrahepatic portal hypertension were achieved with early empiric antibiotic and 
local thrombolytic therapy. Our patient's case underscores the importance of 
recognizing Fusobacterium bacteremia as a possible cause of suppurative PVT 
after disruption of the gastrointestinal mucosa following an acute 
intraabdominal infectious process. Early treatment of this condition using 
anticoagulation and endovascular thrombolysis as adjunctive therapies may 
prevent PVT complications.