Callahan and colleagues describe a group of 30 patients seen during 5 years at San Francisco General Hospital with NSTI from illicit drug injections. This small, but remarkable, subgroup of 3560 patients with cutaneous abscesses from illicit drug injection experienced a 20% mortality. The authors, having sought clinical clues to differentiate patients with NSTI from those with simple cutaneous abscesses, concluded that a high index of suspicion and an inquisitive operative approach were necessary to avoid missing these serious infections.