<p>As an effective alternative therapy, acupuncture is increasingly recognized and utilized worldwide. While acupuncture is used to treat neurological, respiratory, and circulatory disorders, its clinical efficacy is influenced by various factors. Even minimal stabbing wounds may cause physical injury or be life-threatening if done improperly. We report the case of a young man who died suddenly after receiving acupuncture treatment. Autopsy revealed multiple needlestick wounds in the bilateral lungs, liver, and spleen, leading to traumatic pneumothorax and hemoperitoneum, and the man ultimately died of respiratory failure. Notably, the case documentation mentioned only dorsal acupuncture. However, during the autopsy, we discovered additional puncture sites in the bilateral lateral regions, with dimensional discrepancies compared to the dorsal needlestick. We hypothesized that these discrepancies were caused by the use of needles of varying sizes and raised reasonable suspicion of multiple perpetrators. A subsequent law enforcement investigation confirmed that the man’s dorsal and lateral acupuncture were performed separately by a masseur at a private clinic and by his partner. A detailed analysis clarified how injuries to different anatomical regions contributed to the fatal outcome, providing a foundation for legal accountability. The uniqueness of this case lies in the involvement of multiple suspects, multiple organ injuries, and unlicensed medical practice. This case not only enriches the report on adverse events associated with acupuncture but also highlights the critical importance of meticulous forensic examination and comprehensive case investigation.</p>