A 14-year-old boy presented with fever and progressive respiratory distress, one week after an episode of pharyngitis. Although there was a concern about pulmonary embolism secondary to a lower extremity fracture, his presentation was most consistent with Lemierre syndrome. This syndrome is an uncommon but potentially lethal complication of otolaryngological infections. Early recognition and aggressive antibiotic therapy are critical elements in reducing mortality. Emergency physicians should be aware of this syndrome because its incidence appears to be increasing.