A 51-year-old man, taking beverage containing inorganic germanium (Ge), (90-100 mg/day, total 70 g) for two years, developed body weight loss, anemia, renal dysfunction, peripheral neuropathy, myopathy, autonomic dysfunctions and multiple cranial nerve palsies. Serum CK, GOT, LDH, BUN, and creatinine levels were elevated. The cerebrospinal fluid showed albumino-cytologic dissociation. Sural nerve biopsy showed axonal degeneration, and peroneal muscle biopsy showed neurogenic changes including type 2 fiber atrophy and ragged red fibers. High level of Ge content was detected from the hair and nail by inductively coupled plasma atomic emission spectrometry. Despite discontinuation of Ge taking, the peripheral neuropathy and autonomic dysfunction progressed. The symptoms remained unchanged even in the treatment with prednisolone. These findings suggest that inorganic Ge has a serious irreversible multiple system toxicity.