A 51-year-old man showed up at a hospital in Germany looking as though he was wasting away, with swelling and tenderness in his ankles and knees. Then, his heart stopped.

Doctors were able to resuscitate him. Then, they got to work trying to figure out what was wrong. The man told them that for three months he had been suffering from diarrhea, weight loss, joint pain, and fever. His case was reported in this week's issue of the New England Journal of Medicine.

Blood tests didn't detect any infection, but imaging of his heart told a different story. Doctors saw "vegetation" on both his aortic valve and mitral valve. Vegetations are clumps or masses that often build up from an infection, generally containing a bundle of proteins, platelets, and infecting germs stuck together. While they cause damage where they are, if they fully dislodge, they threaten to move to other parts of the body, such as the brain or lungs, and cause dangerous blockages. In the man's case, the vegetation on his aortic valve appeared mobile.

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About two months after receiving a donated kidney, a 61-year-old man ended up back in the hospital. He was tired, nauseous, and vomiting. He was also excessively thirsty and producing too much urine. Over the next 10 days, things only got worse. The oxygen levels in his blood began to fall. His lungs filled with fluid. He kept vomiting. He couldn't eat. Doctors inserted a feeding tube. His oxygen levels and blood pressure kept falling. He was admitted to the intensive care unit and put on mechanical ventilation. Still, things kept getting worse.

At that point, he was transferred to the ICU of Massachusetts General Hospital, where he had received the transplant. He was in acute respiratory failure and shock.

In a case report in this week's issue of the New England Journal of Medicine, doctors at Mass General explained how they determined what was wrong with the man. Their first steps were collecting more information about the man's symptoms from his wife, reviewing his family medical history, and contacting the regional organ-procurement organization that provided the kidney.

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