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 Ipecac Ipecac projectile at Isaac, which leaves Green Creep on impact.
  • Summons two Charger Chargers or Spitty 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 Fly 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 Trite Trites instead of Chargers or Spitties. He cannot spawn more than 3 Trites at once. It spawns Spider 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.
    • Despite not being a true Horseman, Added in Repentance Ultra Pestilence Ultra Pestilence still appears instead of an ultra version of Conquest Conquest during Added in Repentance The Beast The Beast fight.
  • Pestilence means a fatal disease epidemic.
  • Pestilence is the only Harbinger that does not have a charge attack.
  • Removed in Repentance Pestilence’s head resembles The Husk The Husk.
  • Pestilence makes a "Hey!" sound when launching explosive projectiles at Isaac. Famine Famine makes the same noises when spitting shots at Isaac at its second phase.