A 46-year-old woman had 1-month-old erythematous papules on the left elbow and both knees where acupuncture with gold needles had been performed twenty years earlier. She also had a 2-month-old pruritic scar lesion on the nape. Histopathologic findings showed sarcoidal granulomas. The presence of silica components in the granulomas was confirmed by scanning electron microscopy (SEM) of the lesion on the nape and energy dispersive X-ray microanalysis (EDXA) of the lesions on the nape and the left elbow. We suggest that acupuncture with gold needles may be one cause of silica granuloma.