Differential Diagnosis for Intermittent Facial and Neck Swelling

The patient presents with a complex set of symptoms including intermittent facial and neck swelling, dysphagia, hoarseness, excess saliva production, and occasional unilateral eyelid swelling, alongside a history of lung nodules and bilaterally enlarged parotid and submandibular glands. The following differential diagnoses are categorized based on their likelihood and potential impact:

• Single Most Likely Diagnosis
  • Sjögren's Syndrome: Given the patient's symptoms of excess saliva production, occasional numbness of the tongue, and the presence of bilaterally enlarged parotid and submandibular glands, Sjögren's syndrome is a strong consideration. The patient's ANA of 1:40 with a nuclear speckled pattern further supports this diagnosis, although the negative SS-A and SS-B antibodies do not rule it out entirely.
• Other Likely Diagnoses
  • IgG4-Related Disease: This condition can cause swelling of the salivary and lacrimal glands, among other symptoms, and could explain the patient's glandular enlargement and occasional eyelid swelling.
  • Sarcoidosis: Although less common, sarcoidosis could explain the lung nodules, glandular enlargement, and some of the patient's other symptoms, especially if there's involvement of other organs.
• Do Not Miss Diagnoses
  • Lymphoma: Given the long-standing nature of the patient's symptoms and the presence of lung nodules, lymphoma is a critical diagnosis not to miss. It could explain many of the patient's symptoms, including glandular enlargement and systemic symptoms.
  • Parotid and Submandibular Gland Malignancies: Although less likely, malignancies of these glands could present with similar symptoms and must be considered, especially with the significant glandular enlargement.
• Rare Diagnoses
  • Melkersson-Rosenthal Syndrome: Characterized by recurrent facial paralysis, swelling of the face and lips, and the development of folds and furrows in the tongue (fissured tongue), this syndrome is rare but could explain some of the patient's symptoms.
  • Heerfordt's Syndrome (Uveoparotid Fever): A form of sarcoidosis that affects the eyes and salivary glands, it's a rare condition that could potentially explain some of the patient's symptoms, especially if there's eye involvement.

Each of these diagnoses requires careful consideration and further investigation to determine the underlying cause of the patient's symptoms. Given the complexity and the potential for serious underlying conditions, a comprehensive diagnostic approach is necessary.