What is the most common initial presenting sign of Wegner's granulomatosis?

Wegener's granulomatosis, now known as granulomatosis with polyangiitis, often presents with upper respiratory tract symptoms and specifically, rhinitis is a common initial sign. Patients may experience nasal congestion, epistaxis (nosebleeds), and nasal discharge due to inflammation and necrosis of the nasal mucosa. The characteristic upper respiratory symptoms are a result of the disease's propensity to affect the sinuses and the nasal passages early in its course.

While hematuria, dyspnea, and fever can certainly occur in Wegener's granulomatosis, they are more commonly associated with later stages of the disease or when there is significant renal or pulmonary involvement. Hematuria typically indicates renal involvement, which may not present until the disease has progressed. Dyspnea can reflect pulmonary manifestations, but respiratory symptoms in the early stages often start with upper respiratory signs like rhinitis. Fever can occur but is generally not the hallmark initial presentation and may arise from systemic effects as the disease progresses.

Thus, rhinitis stands out as the most common initial presenting sign of this condition, making it the correct answer. Recognizing these early signs allows for prompt diagnosis and treatment, which is critical for managing Wegener's granulomatos