A 55-year-old, college-educated man had a 2-year history of a pronounced preoccupation with internet pornography. The patient needed to seek and view pornography throughout the day and even on a laptop while sitting in restaurants and other public places. In addition, he developed frequent masturbation. He had other personality changes. He had decreased goal-directed activities and verbal output. He had flatulence, eructation, and urination in public without excusing himself or showing embarrassment. He constantly ate sweets, gaining 100 lbs. In 1 year, and his self-care declined; he tended to wear the same clothes every day. The patient became emotionally disengaged; for instance, he failed to inquire about his father dying from cancer. When confronted with his behavior, he denied any changes in his personality. He had otherwise negative past medical and family histories except for late dementia in a grandmother. On examination, his Mini-Mental State Exam score was 27/30. His language was sparse but fluent. His 10-minute delayed recall was only 1/10 words; however, his memory for current events was intact even for details. The patient could do visuospatial constructions but failed Luria alternating programs and was concrete on proverb interpretations. The rest of his examination revealed intact cranial nerve, sensorimotor, and reflex testing. MRI was unremarkable, but positron emission tomography showed frontal and anterior temporal hypometabolism, right worse than left. This patient met criteria for FTD. He received escitalopram, a selective serotonin receptor inhibitor (SSRI), with a modest decrease in his viewing of pornography.