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IsaacHDXxx form2Isaac scribble RebirthKeeper sprite

BC Pestilence
Art by Edmund McMillen
Floor(s) The Caves



Headless Horseman

Item Drop(s) Cube of Meat
Rebirth Stats

Pestilence, one of the four Horsemen of the Apocalypse, is a boss which can be encountered instead of a traditional boss in the Caves and Catacombs once the player has beaten the game for the first time (killed Mom). He is a bloated, diseased, and zombie-like being that lazily leans back on his rotting steed as it carries him around.

Pestilence is guaranteed to be the boss when Book Of Revelations is used in the Caves or the Catacombs (unless the Headless Horseman appears in his place).

This boss has two main phases:

Phase 1


  • Like Sloth, he fires a lobbed projectile similar to IPECAC, which explodes on contact, and does one heart of damage only. As Well, Pestilence says "hey". It also leaves a pool of green creep upon exploding.
  • His movement leaves a large, green creep.
  • He summons Chargers and Spitties periodically.

Phase 2

Pestilence headless

  • After reducing his health to one half, his head is destroyed, leaving his body still mounted on his horse. It still leaves the green puddles of creep wherever it goes and fires the green bombs more rapidly. Also, the horse begins to summon red and black Flies, with the same coughing sound as the Hive (to compensate for the fact that he is no longer able to summon Chargers and Spitties during this phase).

Champion Variants

Pestilence white

Phase 1 shoots 6 white bullets and summons Trites. Also leaves a white creep (similar to the Widow's) that slows down Isaac if stepped on.

Phase 2 summons a small Spider and shoots 6 blood bullets.



  • Pestilence quote often erroneously replaces Conquest in popular culture. The actual text of the Revelation describes Conquest as the first of the four horsemen of the Apocalypse (described as a rider with a bow on a white horse (Rev. 6:2)) and makes no mention of Pestilence.
    • "A Forgotten Horseman" achievement might be a reference to the fact that Conquest is often forgotten in popular culture.
  • Pestilence is the only horseman in the game that doesn't grab his horse. (Excluding the Headless Horseman)
  • Pestilence means a fatal epidemic disease


  • Occasionally, regular Pestilence will fire three of its shots at once, like a Super Sloth. It can fire as many as 8 of these shots in a rapid succession.
    • Mostly of the time this happens Pestilence will not show its animation.
  • Occasionally, as soon as the battle with Pestilence begins, he will fire a single IPECAC shot towards Isaac while he is in the doorway without showing his animation.
  • Pestilence may glitch into the wall if you push him hard enough, rendering the fight impossible.
  • Pestilence can take poison damage (via The BeanThe Common ColdBob's Rotten HeadThe Virus, and Bob's Curse), but his sprite will not change color.
  • If killed by the white Champion Pestilence's shots, Isaac's Last Will will state that he was killed by a Gusher.


The Harbingers Related
Famine Pestilence War Death Conquest Headless ingame
Famine Pestilence War Death Conquest Headless Horseman
Basement Larry Jr.MonstroThe Duke of FliesGeminiStevenFamine
Cellar WidowPinThe Duke of FliesFamineGurdy Jr.The Blighted Ovum
The Caves FistulaPeepGurdyChubC.H.A.D.Pestilence
Catacombs The HuskThe HollowThe Blighted OvumThe Carrion QueenPeepPestilenceThe WretchedGurdy Jr.
The Depths LokiMonstro IIGishWarMom
Necropolis Mask of InfamyDaddy Long LegsThe Carrion QueenThe BloatLokiWarThe WretchedMom
The Womb ScolexBlastocystThe BloatDeathConquestDaddy Long LegsTriachnidTeratomaMom's HeartIt Lives
Utero TeratomaThe BloatDeathConquestDaddy Long LegsTriachnidLokiiMom's HeartIt Lives
Sheol The FallenSatan
Cathedral Isaac
The Chest ???
First to fifth and seventh level The FallenHeadless Horseman
Devil Room Krampus

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