A man in his 60s, who was diagnosed as having postoperative recurrent gastric cancer with lymph node and spinal metastases, was admitted to our palliative care unit (PCU). He was unable to receive further aggressive chemotherapy for cancer because of bilateral hydronephrosis and chronic renal failure. He had chronic urethral infection and hence required continuous antibiotic administration. Although his infection was well controlled with antibiotics, his oral intake gradually declined. Seventeen days after admission, he developed systemic hemorrhage, including hematuria and oral bleeding. Coagulation tests revealed that the patient had markedly prolonged prothrombin time (PT) and activated partial thromboplastin time (APTT) but no thrombocytopenia, fibrinogen consumption, or increased fibrin/fibrinogen degradation products (FDP) level. Serum level of protein induced by vitamin K absence or antagonist II (PIVKA-II) was markedly high, and vitamin K level was below the lower limit of the reference range. After he was administered intravenous vitamin K, his symptoms markedly improved. Many patients with advanced cancers tend to have malnutrition, anorexia, and chronic infection that require antibiotic administration. Prophylactic administration of vitamin K might be sometimes necessary for preventing catastrophic hemorrhage.

Introduction: We report two cases of infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients treated by the palliative care team during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. These patients were receiving interventions for pain control, but subsequently contracted COVID-19, leading to their deaths. Cases: Two patients with hematopoietic tumors had been taking hydromorphone tablets for pain control. Both patients contracted COVID-19 during their clinical course, and displayed happy hypoxia, a typical complication of SARS-CoV-2 infection. Although the rapid systemic deterioration of the patients' conditions were recognized, there were no complaints of breathing difficulties. We attempted to alleviate the symptoms by adjusting the medications, including changes to the administration route. Discussion: When a patient receiving palliative care is infected with SARS-CoV-2, the presence of an underlying condition may cause a rapid deterioration, and opioid titration may be required depending on the characteristics of the symptoms.