Which of the following is NOT among the five most common clinical manifestations of microscopic polyangiitis?

• A. Kidney inflammation
• B. Weight loss
• C. Skin lesions
• D. Hearing loss

Answer: (D)

Microscopic polyangiitis typically affects small vessels and most often hits organs with rich microvasculature. The common clinical manifestations reflect that pattern: kidney inflammation from pauci-immune glomerulonephritis, constitutional symptoms such as weight loss and fever, skin involvement like palpable purpura from leukocytoclastic vasculitis, and peripheral neuropathy. Pulmonary involvement, including alveolar hemorrhage, can also occur, contributing to a pulmonary-renal syndrome. Hearing loss is not a typical feature of microscopic polyangiitis; it is more associated with granulomatosis with polyangiitis, which often involves the upper airways and middle ear. So the feature not usually seen among the main manifestations is hearing loss.