A rapidly progressive disease with multiple organ involvement and symptoms of polyuria and polydipsia developed in a 32-year-old woman, with an initial presentation of xanthoma disseminatum. Within 6 months increasing visual impairment of the right eye developed; a computed tomographic scan revealed multiple cerebral and cerebellar lesions. Progress of her disease resulted in blindness of the right eye, internal hydrocephalus with involvement of both ventricles, and cerebellar ataxia. Ultrasound examination of the abdomen and a subsequent endoscopic retrograde cholangiopancreatographic examination revealed a xanthomatous gallbladder and liver involvement. The gallbladder and liver showed histologic changes compatible with xanthomatosis. The patient died 4 years after the appearance of skin lesions.