A 41-year-old white woman was referred with a 3-week history of swelling involving the medial canthus, parotid gland, and lacrimal gland area bilaterally. Medical history was positive for morbid obesity, seasonal allergies, depression, spinal stenosis, and psoriasis. Medications included cetirizine, escitaplopram oxalate, furosemide, celecoxib, zaleplon, and allergy shots. Until 8 months prior to our initial examination, the patient was receiving methotrexate for psoriasis. Review of systems was positive for back and joint pain, xerostomia, daytime somnolence, and snoring.