The Sword is a secret item in the Karamari Hospital DLC that can be unlocked in New Game + mode. The Sword works identically to the Axe; with the exception that it kills The Virus, Monster 1, Monster 2, Monster 3 (temporarily), Monster 4, Monster 5, and Monster 7. Successfully killing all monsters will trigger an alternate ending.
The Sword can be seen in a painting within the office containing the entrance to the basement. To pick it up you need to press E while looking at the painting. The Sword will permanently replace the Axe.
- There is a glitch that once the player has equipped the Sword, saves the game and reloads it, the Sword will not work properly (won't affect enemies) and play incorrect sounds, to repair it, the player needs to pick it up from the painting again.
- There is also a glitch that once the player finishes the game with the Sword and clicks new game, they will still have the Sword, however, it will not affect enemies until the player takes it from painting once again.
- The Virus can only be killed once the player turns the power off.
- Additionally, once killed, the acid bottle will not appear.
- Monster 3 is the only monster that can re-appear after being killed.
- When a sitting soul appears, the player can destroy it with the Sword and sit down again.
- However, if the player sits again, they will be trapped and die after a few seconds.
- When the player kills Monster 2, he will be immediately teleported out of his trap room.
- Monster 6 is the only enemy which cannot be killed with the Sword.
- The Sword is not available in Endless Mode.