This condition, if primary, has been historically designated as Mikulicz disease. Although benign, this condition is almost always found along with certain other underlying diseases, such as tuberculosis, leukemia, syphilis, hodgkin's disease, sarcoidosis, systemic lupus erythematosus or Sjogren's syndrome. The appropriate terminology for this condition then becomes Mikulicz syndrome [1]. Such designations are now considered outdated and ambiguous. Some authors believe that Mikulicz disease, Mikulicz syndrome as well as Sjogren's syndrome all refer to the same condition- an autoimmune lymphocytic inflammation of the salivary and lacrimal glands due to a hyperactive immune response [2] [3] [4].

Owing to the inflammatory processes occurring in the enlarged parotid and other salivary glands, Mikulicz disease patients are usually affected by xerostomia of a sudden onset that may present as dysphagia or dental problems. The enlargement of the lacrimal glands, on the other hand, may lead to a reduction or absence of tear secretion.

Painless swellings of the parotid and other salivary glands may be found in these patients. Other glands, such as the submaxillary and the buccal glands, may also be involved. Uveitis is another commonly seen clinical sign. This disease is usually long-lasting and recurring fevers may be observed in some patients [5] [6].

Mikulicz disease may also be known by a variety of names including Dacryosialoadenopathia, Mikulicz-Radecki syndrome, Mikulicz-Sjogren's syndrome. Several other conditions, having similar clinical manifestations, should be considered in the differential diagnosis of Mikulicz disease.

Mumps, an acute viral disease of childhood was a leading cause of enlargement of the salivary glands before the advent of prophylactic mass vaccinations. Unlike Mikulicz disease, the inflammation of the glands is usually painful in mumps. The first symptoms may further include malaise, loss of appetite and a low-grade temperature that rises quickly within the first 24 hours.

Heerfordt’s syndrome, characterized by the enlargement of the parotid glands accompanied by the paralysis of the facial nerve should also be excluded. It is an early feature of sarcoidosis.

Salivary gland duct obstruction due to stones may also be a cause for glandular enlargement and should be considered in the differential diagnosis. Other reasons for salivary gland swelling include malnutrition, chronic alcoholism, pregnancy and the use of certain medications such as iodine. Salivary gland tumors, both benign and malignant, should also be ruled out while making a diagnosis [7] [8].

• Muscle Rigidity

  These drugs have the ability to prevent muscle spasms and were first developed to prevent muscle rigidity associated with seizures. Thus, patients who look up Klonopin are surprised to see that it was first approved for children with seizures. [dry.org]

• Polydipsia

  He developed polyuria and polydipsia after initiation of steroid therapy. Plasma and urine osmolality were suggestive of central diabetes insipidus (Table I). His serum Anti-Diuretic Hormone (ADH) was not estimated. [journals.viamedica.pl]

• Dental Caries

  Xerostomia Dental caries Early loss of teeth Dry & smooth oral mucosa Cracking & Fissuring at corner of mouth.Management Good oral hygiene. 10. Hyperplasia Cause- Hormonal MetabolicClinical features Site minor salivary glands of palate. [slideshare.net]

  In addition to chronic dryness, the patients have troublesome intraoral soft tissue problems that include rampant dental caries and difficulty with dentures due to dryness. [dry.org]

• Lacrimal Gland Enlargement

  Historically, bilateral parotid and lacrimal gland enlargement was characterized by the term Mikulicz's disease if the enlargement appeared apart from other diseases. [en.wikipedia.org]

  Lacrimal gland enlargement, parotid gland enlargement, dry mouth and dry eyes are the classic signs. The exact cause of Mikulicz syndrome is not known. Some scientists believe that Mikulicz syndrome should be considered a form of Sjögren syndrome. [rarediseases.org]

  Lacrimal gland enlargement was observed in 8 cases. Other lesions included orbital pseudotumor in 5, pituitary enlargement in 5, and cranial nerve enlargement in 7; the infraorbital nerve was involved in 4. [ajnr.org]

  Role of Th2 cells in IgG4-related lacrimal gland enlargement. Int Arch Allergy Immunol 2010;152(Suppl. 1):47-53. Yamada K, Kawano M, Inoue R et al. [eyewiki.aao.org]

• Absent Lacrimation

  A dictionary of medical eponyms Related people Henrik Samuel Conrad Sjögren Jan Mikulicz-Radecki Benign and chronic dacryoadenitis with bilateral painless swelling of lacrimal and salivary glands and decreased or absent lacrimation. [whonamedit.com]

• Abnormal Involuntary Movement

  involuntary movement scale ) 免疫グロブリンG ( immunoglobulin G ) WebLSDに未収録の専門用語（用法）は "新規対訳" から投稿できます。 [life-science-dictionary.com]

Mikulicz disease is suspected in patients presenting with a simultaneous enlargement of the parotid and lacrimal glands.

Biopsy may be required to establish the reason for the enlargement of these glands. Histological findings in Mikulicz disease include lymphocytic infiltration in the salivary and lacrimal glands. Autoantibodies, such as anti-Ro, anti-La, antinuclear antibodies (ANA) and rheumatoid factor may also be detected in the serum.

Dry eye may be objectively diagnosed by certain tear flow dynamic tests, including the schirmer test, cotton thread test, clearance test or the tear break-up time test. Changes in the ocular surface may be detected via staining with the rose bengal or fluorescein stains [9] [10].

• Antinuclear Autoantibodies

  The following factors having a possible association with the presence or absence of MD were investigated: sex; serum IgG and IgG4 levels; the presence or absence of antinuclear autoantibodies, jaundice, diabetes mellitus, swollen duodenal papilla, diffuse [ncbi.nlm.nih.gov]

  A critical evaluation of enzyme immunoassays for detection of antinuclear autoantibodies of defined specificities. I. Precision, sensitivity, and specificity. Arthritis Rheum 42:455. 23. Vivino, F. B., I. Gala, and G. A. Hermann. 2002. [dry.org]

• Thrombocytosis

  In hyper-IL6 syndromes, the levels of IgG, IgA, IgM, and CRP are mostly elevated, and thrombocytosis, anemia, hypoalbuminemia and hypocholestrolemia are observed due to the effects of the high IL-6 levels. [synapse.koreamed.org]

1. Ihrler S, Harrison J. Mikulicz's disease and Mikulicz's syndrome: analysis of the original case report of 1892 in the light of current knowledge identifies a MALT lymphoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(3):334-9.
2. Yousem D, Kraut M, Chalian A. Major salivary gland imaging. Radiology. 2000;216(1):19-29.
3. Morgan W, Castleman B. A clinicopathologic study of “Mikulicz’s Disease. Am J Pathol. 1953;29:471-503.
4. Morgan W. The probable systemic nature of Mikulicz’s disease and its relation to Sjögren’s syndrome. N Engl J Med. 1954;251:5-10.
5. Lemp M. Report of the National Eye Institute/industry workshop on clinical trials in dry eyes. CLAO J. 1995;21:221-232.
6. Fox R, Robinson C, Curd J, Kozin F, Howell F. Sjögren’s syndrome: proposed criteria for classification. Arthritis Rheum. 1986;29:577-583.
7. Mikulicz J. Ueber eine eigenartige symmetrische Erkrankung der Tranen und Mundspeicheldrusen (Concerning a peculiar symmetrical disease of the lacrimal and salivary glands). Medical Classics. 1937;2:165-186.
8. Miracco C, Schurfeld K, Cardone C, et al. Benign lymphoepithelial lesion associated with squamous cell carcinoma of the skin: an immunohistochemical and molecular genetic study. J Cutan Pathol. 2002;29:33-37.
9. Toda I, Shimazaki J, Tsubota K. Dry eye with only decreased break-up time is sometimes associated with allergic conjunctivitis. Ophthalmology. 1995;102:302-309.
10. Tsubota K, Fujita H, Tsuzaka K, al. e. Mikulicz’s disease and Sjögren’s syndrome. Invest Ophthalmol Vis ScI. 2000;41:1666-73.