Bilateral parotid gland enlargement has a wide range of differential diagnoses, however for this case Mikulicz disease is favored due to:

• involvement of two or more salivary glands and lacrimal glands
• history of intermittent facial swelling, dry eyes and xerostomia
• ANA was positive with negative anti-Ro
• IgG4 levels were elevated
• histopathological examination revealed lymphocytes with a predominance of mononuclear cells
• good response to corticosteroids

It is important to suggest Mikulicz syndrome because studies show that affected patients are 43% more likely to get lymphoma than the general population.

Also important to screen for other IgG4 diseases in these cases