Background: Acute retinal pigment epitheliitis (ARPE) presents with decreased or distorted vision caused by single or multiple macular lesions in an otherwise healthy eye. While prognosis for visual recovery is good, the retinal lesions remain clinically evident long after the acute phase. Case Report: A 42-year-old white male presented with a history of acute onset visual distortion OS. Dilated examination revealed several macular lesions OS. Serial fundus photography over 18 months showed progressive pigment atrophy and migration. While time domain optical coherence tomography (OCT) at the initial presentation did not pinpoint any lesions, high resolution fourier domain OCT performed 18 months later found identifiable lesions with marked thinning and atrophy of the RPE and deep retinal layers. Conclusion: The initial presentation represents a rare case of ARPE during the resolution of the active phase. Serial fundus photography and fourier domain OCT are presented as useful tools to monitor this condition.