Necrotizing aortitis is a rare and life-threatening complication of local or generalized bacterial infections and most commonly affects the abdominal aorta. We described a case of a 79-year-old man with an acupuncture-induced bacterial aortitis associated with pseudoaneurysm formation causing near rupture. The patient underwent emergent explolapartomy, resection of the infected aorta, wide debridement of surrounding infected tissues, and extra-anatomic axillary to bifemoral graft bypass. The microbiologic examination revealed Escherichia coli and methicillin resistant Staphylococcus aureus (MRSA). Necrotizing aortitis is very serious and fatal disease, careful history taking as well as rapid diagnosis and urgent treatment are of critical importance.