Binding of Isaac: Rebirth Wiki
Binding of Isaac: Rebirth Wiki

Pestilence is a Harbinger that can appear in all environments of Chapter 2 (Caves Caves, Catacombs Catacombs, Added in Afterbirth Flooded Caves Flooded Caves).


Phase 1[]

  • Floats around the room, leaving a large trail of damaging Green Creep.
  • Fires an 15►Ipecac Ipecac projectile at Isaac, which leaves Green Creep on impact.
  • Summons two Chargers or Spitties and can have a maximum of four summons.
    • Any Chargers or Spitties caught in Pestilence's Ipecac explosion will be killed.

Phase 2[]

After taking enough damage, Pestilence's head will explode, beginning the second phase.

  • No longer moves around the room but slowly drifts around, leaving Green Creep.
  • Continues to fire Ipecac projectiles at Isaac, but at a faster rate.
  • Summons two Attack Flies.

Pestilence deals a whole heart of contact damage in both phases, though without flight Isaac is more likely to be damaged by the Green Creep instead.

Champion Versions Needs to be unlocked[]

  • Pale Grey: Leaves a trail of slowing White Creep instead of Green Creep, shoots 6 projectiles in all directions instead of an Ipecac shot and spawns Trites instead of Chargers or Spitties. He cannot spawn more than 3 Trites at once. It spawns Spiders instead of Attack Flies in Phase 2.


Unlockable achievements[]


  • Pestilence appeared in the original The Binding of Isaac.
  • Pestilence is not directly one of the Four Horsemen of the Apocalypse and is not present with the other Horsemen in Revelations (Revelation 6:2). The canonical Four Horsemen are Conquest (white), War (red), Famine (black), and Death (pale).
    • However, pestilence is featured as one of God's "four disastrous acts of judgment" alongside sword, famine, and wild beasts (Ezekiel 14:21), which, in some cases, can be interpreted as symbolic of the Horsemen- as the acts of judgement are often used by God for destructive purposes throughout the Bible.
      • These four acts are given to the Horseman of Death to perform (Revelation 6:8) despite the contradictory fact that famine, the attribute of a completely separate Horsemen is among the acts.
    • Added in Repentance Despite not being a true Horseman, Ultra Pestilence still appears instead of an ultra version of Conquest during The Beast fight.
  • Pestilence means a fatal disease epidemic.
  • Pestilence is the only Harbinger that does not have a charge attack.
  • Pestilence’s head resembles The Husk.
  • Pestilence makes a "Hey!" sound when launching explosive projectiles at Isaac. Famine makes the same noises when spitting shots at Isaac at its second phase.

Bosses Boss Monstro.png
Chapter 1
Stage Basement icon.pngStage Cellar icon.pngStage Burning Basement icon.png
GeminiStevenBlighted OvumDingleThe Duke of FliesFamineGurglingsThe HauntLarry Jr.MonstroPinWidowThe FallenThe Headless Horseman
DangleLittle HornRag ManTurdlings
Baby Plum
Chapter 1.5
Stage Downpour icon.pngStage Dross icon.png
Lil BlubWormwoodThe RainmakerMin-MinClogColostomiaTurdlet
Chapter 2
Stage Caves icon.pngStage Catacombs icon.pngStage Flooded Caves icon.png
FistulaChubC.H.A.D.Carrion QueenDark OneGurdyGurdy Jr.The HollowThe HuskMega FattyMega MawPeepPestilencePolycephalusThe WretchedThe FallenThe Headless Horseman
The ForsakenThe FrailThe Stain
Big HornRag Mega
Chapter 2.5
Stage Mines icon.pngStage Ashpit icon.png
Reap CreepTuff TwinsHornfelGreat GideonSingeThe ShellThe Pile
Chapter 3
Stage Depths icon.pngStage Necropolis icon.pngStage Dank Depths icon.png
The AdversaryThe BloatThe CageThe GateMonstro IIGishLokiMask of InfamyWarThe FallenThe Headless HorsemanMom
Sisters Vis
Reap CreepThe Pile
Chapter 3.5
Stage Mausoleum icon.pngStage Gehenna icon.png
The SirenThe HereticThe VisageThe Horny BoysMomMom's Heart
Chapter 4
Stage Womb icon.pngStage Utero icon.pngStage Scarred Womb icon.png
BlastocystThe BloatConquestDaddy Long LegsTriachnidDeathLokiiMama GurdyMr. FredScolexTeratomaThe FallenThe Headless HorsemanMom's HeartIt Lives
Sisters VisThe Matriarch
Stage Corpse icon.png
ChimeraThe ScourgeRotgutMother
Chapter 5
Stage Sheol icon.pngStage Cathedral icon.png
Chapter 6
Stage Dark Room icon.pngStage Chest icon.png
???The LambMega Satan
The Void
Stage The Void icon.png
Stage Home icon.png
DogmaThe BeastUltra DeathUltra FamineUltra PestilenceUltra War
Greed Mode
Ultra Greed
Ultra Greed
Ultra Greedier
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