The concreteness effect, which refers to the typically superior performance for concrete concepts compared to abstract ones, is a robust phenomenon that has been observed in normal and brain-damaged subjects in a number of cognitive domains. Reversal of this effect was also reported in a few neuropsychological studies, mainly in patients with semantic dementia (SD). In this article, we report the first longitudinal single-case study of a patient with SD, SC, who performed better for abstract than concrete concepts in various comprehension and production tasks. For concrete concepts, SC showed no category-specific deficit but was impaired in tasks exploring access to stored structural knowledge and semantic perceptual attributes. With the course of the disease, the semantic system progressively declined and the reversal of the concreteness effect, as well as the dissociation between perceptual and non-perceptual knowledge, vanished. We discuss the results and their implications for theoretical propositions of concreteness effect as well as theoretical models of semantic memory. We suggest that the reversal of concreteness in SC is a direct result of the degradation of visual feature knowledge, sustained by anatomical structures affected early in SD. With the time course of the disease, the atrophy extends to adjacent regions and the dissociation between abstract and concrete concepts was no longer observed.