<p>Acupuncture is increasingly used worldwide as a treatment option for conditions such as chronic low back pain. But it is not without risk and infection following acupuncture is a serious acupuncture-related adverse event and is often difficult to diagnose early. We submitted a set of Medical Images of pyogenic perivertebral infection following acupuncture in an 18-year-old female. We succinctly discussed its imaging appearance, diagnosis, and treatment. The pyogenic spinal infection following acupuncture is usually of temporal and anatomical plausibility with direct inoculation mechanism distinct from hematogenous spondylodiscitis. Acupuncture is a safe intervention only when practiced by appropriately trained practitioners using clean technique and disposable single-use needles. It is essential for acupuncturists, clinicians, and patients to be fully aware of the potential risks of acupuncture.</p>