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Boss Pestilence.png
Base HP
Stage HP
Found In
Stage caves.png Stage catacombs.png Stage flooded caves.pngSuper Secret Room Icon.png
(Later Floors)
Dropped Items
Ball of BandagesBall of Bandages
Cube of MeatCube of Meat

Unlocked By
The Harbingers Defeat Mom for the 1st time

Pestilence is a boss that can appear in The Caves, The Catacombs, and the Flooded Caves. It is one of the four Harbingers, and the horseman of Chapter 2.

Behavior[edit | edit source]

Phase 1[edit | edit source]

  • Pestilence will float around the room, leaving a trail of poison.
  • In addition to the trail of poison, it will fire explosive projectiles at Isaac which too, leave poison.
  • Pestilence can also summon up to four Chargers or Spitties.

Phase 2[edit | edit source]

  • Pestilence is now headless.
  • It will keep firing the explosive projectiles at Isaac.
  • Instead of Chargers or Spitties, Pestilence will summon Attack Flies.

Champion versions[edit | edit source]

  • White: This version leaves a trail of white creep, which slows the player down and shoots 6 bullets away from itself instead of explosive shots. It spawns Spiders instead of flies in Phase 2.

Unlockable achievements[edit | edit source]

Gallery[edit | edit source]

Trivia[edit | edit source]

  • Pestilence appeared in the original Binding of Isaac.
  • Pestilence, while very often portrayed as one of the Four Horsemen of the Apocalypse in popular culture, is actually not present in the Bible at all (see Rev 6:2) and is an example of incorrect interpretation. The canonical Four Horsemen are Conquest (white), War (red), Famine (black) and Death (pale).
  • Pestilence means a virulent or fatal disease epidemic.
    • The entirety of Pestilence's offense deals with poison and bugs that are associated with rot.
  • Pestilence is the only Harbinger that does not have a charge attack.
  • Pestilence’s head resembles The Husk.

Bosses Boss Monstro.png
Chapter 1 Blighted OvumDingleThe Duke of FliesFamineFistulaGeminiGurdy Jr.GurglingsThe HauntLarry Jr.MonstroPinStevenWidow
Added in Afterbirth DangleLittle HornRag ManTurdlings
Chapter 2 C.H.A.D.ChubDark OneGurdyGurdy Jr.The HollowThe HuskMega FattyMega MawPeepPestilencePolycephalusCarrion QueenThe Wretched
Added in Afterbirth The ForsakenThe FrailThe Stain
Added in Afterbirth † Big HornRag Mega
Chapter 3 The AdversaryThe BloatThe CageCarrion QueenThe GateGishLokiMask of InfamyMonstro IIWarThe WretchedMom
Added in Afterbirth Brownie
Added in Afterbirth † Sisters Vis
Chapter 4 BlastocystThe BloatConquestDaddy Long LegsDeathIt LivesLokiiMama GurdyMom's HeartMr. FredScolexTeratomaTriachnid
Added in Afterbirth Blue Womb Added in Afterbirth Hush
Chapter 5 The FallenIsaacSatan
Chapter 6 ???The LambMega Satan
Added in Afterbirth Greed Mode Added in Afterbirth Ultra Greed
Added in Afterbirth † Ultra Greedier
Added in Afterbirth † The Void Added in Afterbirth † Delirium
Chapters 1-4 The FallenThe Headless Horseman

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