Fahad Al-Saif,1 Ahmed Alhumidi,2 Rama Ayed Alhallaf1 1Dermatology Department, 2Pathology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia Abstract: Dyschromatosis symmetrica hereditaria (DSH) is a rare genodermatosis characterized by various sizes of both hyper- and hypopigmented macules arranged in reticulated patterns on the face and the dorsal aspects of the extremities. There are also cutaneous and extracutaneous abnormalities, but they are rare. As far as we know, DSH associated with immune-mediated conditions has not been reported. We report the first case of DSH, which is associated with cutaneous lupus erythematosus and hyperthyroidism. Keywords: dyschromatosis, genodermatosis, lupus, reticulated, autoimmune