Purpose: Dry needling is a common technique used to treat musculoskeletal pain with the insertion and manipulation of needles in myofascial trigger points. It is similar to acupuncture however it differs in that the needles used are thicker in gauge and often inserted deeper, into muscle. To our knowledge there have been six previous case reports of necrotising soft tissue infections following acupuncture. We report the first known case of necrotising fasciitis following dry needling. Methodology: A retrospective case report of a 71 year old male with necrotising fasciitis. He presented with septic shock, fevers and a 1 day history of increasing neck pain and diarrhoea. The symptoms were sudden in onset and he reported dry needling to same area 2 weeks prior. He had a background of hypertension but was immunocompetent, not diabetic and a non-smoker. Results: He was referred for contrast CT scan of his head, neck, chest, abdomen and pelvis due to non-specific symptoms, and this identified significant fat stranding. He was referred to the Plastic & Reconstructive Surgery unit and proceeded to the operating theatre for exploration and debridement. Intraoperative findings were consistent with necrotising fasciitis and he underwent radical debridement, streptococcus pyogenes was cultured. The patient later had several debridements, negative pressure dressing and eventual reconstruction with a dermal substitute matrix and split skin grafting. Conclusion: We present a rare case of necrotising fasciitis after dry needling. Given the larger calibre needles and deeper insertion, in theory there may be an increased risk of inoculation than with acupuncture. Despite this ours is the first known case associated with dry needling.