Acute boric acid poisoning is a rare clinical emergency. We report the successful treatment of acute boric acid poisoning in a patient with anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis. The patient accidentally ingested a lethal dose of boric acid during hospitalization, presenting with clinical symptoms including nausea, vomiting and dizziness. After hemodialysis treatment, the patient’s symptoms completely resolved without severe complications, and the vasculitis achieved a favorable response. Currently, there is no specific antidote for boric acid poisoning, and hemodialysis serves as an effective treatment modality. Clinical cases of hemodialysis for acute boric acid poisoning are relatively scarce. This case provides valuable reference for the management of acute boric acid poisoning in emergency settings.