Boss Pestilence
Found In
The Caves

The Catacombs
Normal Enemy (Later Floors)

Dropped Items
Ball of Bandages

Cube of Meat

Unlocked By
Defeating Mom for the first time.

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


Phase 1
Pestilence will float around the room, leaving a trail of poison.
•In addition to the trail of poison, he will fire explosive projectiles at Isaac which too, leave poison.
Pestilence can also summon up to four Chargers or Spitties

Phase 2
Pestilence is now headless and will shoot the explosive projectiles randomly rather than directly at Isaac.
•Instead of Chargers or Spitties, Pestilence will summon Attack Flies.

Champion VersionsEdit

White: Will leave a trail of white creep, which slows the player down; and now shoots 6 bullets away from him instead of explosive shots. He now spawns Spiders instead of flies in Phase 2.


  • Pestilence, in some interpretations, is one of the Four Horsemen of the Apocalypse.
    • Conquest is often replaced by Pestilence in popular culture. Originally, Conquest is the first of the horsemen depicted in the Bible (Rev 6:2).
  • Pestilence means a virulent or fatal disease epidemic.
    • The entirety of Pestilence's offense deals with poison and bugs that are associated with rot.



Bosses Boss Monstro
Basement MonstroGeminiDingleLarry Jr.The Duke of FliesGurglingsFistulaStevenFamine
Cellar Gurdy Jr.PinWidowBlighted OvumThe HauntDingleLarry Jr.The Duke of FliesGurglingsFistulaFamine
The Caves ChubGurdyGurdy Jr.Mega MawMega FattyDark OneC.H.A.D.Pestilence
Catacombs The HollowThe HuskPeepPolycephalusThe Carrion QueenThe WretchedDark OnePestilence
The Depths The CageMonstro IIThe AdversaryThe GateLokiGishWarMom
Necropolis The BloatThe Carrion QueenMask of InfamyThe WretchedThe GateLokiWarMom
The Womb Mr. FredScolexTeratomaMama GurdyThe BloatLokiiDeathConquestMom's HeartIt Lives
Utero BlastocystDaddy Long LegsTeratomaMama GurdyThe BloatLokiiTriachnidDeathConquestMom's HeartIt Lives
Sheol The FallenSatan
Dark Room The LambMega Satan
Cathedral Isaac
The Chest ???Mega Satan
Devil Room Krampus
Angel Room Angel
Levels 1-5/7 The FallenThe Headless Horseman
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