Pestilence

Boss Portrait
Base HP	280
Base HP	280
Stage HP	0
Stage HP	0
Ingame Appearance
Entity ID	64.0
Found In	Boss Degraded Boss Main path Alternate path
Dropped Items	Ball of Bandages Cube of Meat
Unlock Method	Defeat Mom

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

Behavior

Phase 1

• Floats around the room, leaving a large trail of damaging Green Creep.
• Fires an 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

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.

Gallery

• 

  Pestilence in-game.

• 

  Pestilence in his second phase.

• 

  Grey Champion Pestilence.

• 

  Grey Champion Pestilence in his second phase.

• 

  Pestilence as one of Delirium's forms.

• 

  Pestilence as seen in Isaac's last will.

• 

  Mini version of pestilence summoned with the 7 seals.

Unlockable achievements

• 

  The Book of Revelations - Defeat a Harbinger.

• 

  7 Seals - Defeat all 5 Harbingers.

Trivia

• 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, 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 is unable to charge out of the room.
• 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.

The Binding of Isaac: Rebirth
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