Lemierre’s disease is characterized by sepsis, often with an oropharyngeal source, secondary septic emboli and internal jugular vein thrombosis (Lancet 1:701–3, 1936. Clin Microbiol Rev 20(4):622–59, 2007). Septic emboli affecting many bodily sites have been reported, including the lungs, joints, bones, and brain. The case report describes an unusual case of Lemierre’s disease in a 64 year old gentleman causing profound sepsis, acute kidney injury, bilateral iliopsoas abscesses and a right hand abscess. To our knowledge, this is the first reported case of Lemierre’s disease in the context of bilateral psoas abscesses, and highlights the ambiguity surrounding the definition of Lemierre’s disease. The clinical literature review highlights the difficulty in definitively diagnosing the condition and offers some suggestions for recognising and refining the diagnostic criterion of Lemierre’s.