We describe a patient, HE, who was left with a remarkably selective deficit in intermediate vision following an infarct in the right occipito-temporal region. Thus, HE was able to group elements by colour and proximity but impaired in grouping based on similarity in shape. This finding supports the notion that grouping may be divided into two general steps: (i) element clustering and (ii) shape configuration, with the latter operation being impaired in HE. As opposed to previous cases with shape integration deficits, HE was able to name objects accurately. Initially, this might suggest that shape integration is not a prerequisite for normal object naming. However, on more demanding tests of visual object recognition, HE's performance deteriorated, with her performance being inversely related to the demand placed on integration of local elements into more elaborate shape descriptions. From this we conclude that shape integration is important for normal object recognition.