Contemporary Aspects of the Atypical Course of Acute and Chronic Somatic Diseases

This article analyzes clinical masking of acute somatic diseases as a predictable consequence of modern demographic and medical transformations. Increasing life expectancy, multimorbidity, polypharmacy, chronic inflammation, and microbiome dysregulation contribute to the attenuation, distortion, or absence of classical clinical symptoms. Key pathophysiological mechanisms of atypical presentations are discussed, with particular focus on acute myocardial infarction and acute appendicitis. Age-related changes, immunosenescence, metabolic alterations, chronic infections, lifestyle, environmental factors, and long-term pharmacotherapy are considered as interacting modifiers of organism reactivity. The role of the gut microbiome as a systemic regulator of immune, metabolic, and neuroendocrine responses is emphasized. A conceptual model is proposed to support a shift in clinical reasoning toward integrated assessment of the patient’s background state. Keywords: clinical masking, multimorbidity, polypharmacy, pathophysiology, acute somatic diseases, microbiome, elderly patients.