Intermediate filaments accumulate abnormally in a variety of cell types in individuals with human inherited giant axonal neuropathy (GAN). A characteristic feature of this disorder is the occurrence of focal axonal enlargements filled with accumulations of neurofilaments. The minimum separations between neurofilaments in sural nerve axons of a patient with GAN were 12-30 nm compared with 24-60 nm in controls. The normal sidearm protrusions which cross-bridge adjacent filaments were rare in GAN. Average minimum neurofilament diameter was 12.4 nm in GAN compared with 10.1 nm in controls. Many axons were devoid of neurofilaments and contained an increased density of microtubules, many of which did not run longitudinally. This disorganization of microtubule alignment may reflect the lack of an associated neurofilament lattice. It is concluded that GAN involves abnormalities of neurofilament cross-linkage to one another and to adjacent microtubules. Mechanisms are discussed which could account for this inherited disorder of intermediate filament organization affecting various cell types.