Pestilence =

Pestilence Portrait
Character Information
Character Type Boss
Floors of


Base Health
Heart flash
Unlocked By Defeating
Mom's Heart
Items Dropped Cube of Meat
Ball of Bandages
Then I saw when the Lamb broke one of the seven seals, and I heard one of the four living creatures saying as with a voice of thunder, “Come.” I looked, and behold, a white horse, and he who sat on it had a bow; and a crown was given to him, and he went out conquering and to conquer.
— Revelation 6:1-2˄ New American Standard Bible (NASB)

Pestilence is an enemy in The Binding of Isaac: Rebirth. It appears as a Boss on The Caves and The Catacombs Floors and as a Monster on later Floors.


Pestilence has two phases which are as follows:

  1. Pestilence will float around the room, occasionally coughing out maggots and firing IPECAC (explosive) tears. As it floats, it will leave a trail of green creep.
  2. Pestilence will lose its head at half health. The horse will cough out Flies and the body will shoot out IPECAC (explosive) tears.

Champion Variants

Pestilence has one Champion variant.

  • Pestilence will be white and leave a white, non-lethal creep trail instead of a green one. It will also shoot 6 bullets in an asterisk pattern instead of IPECAC shots and will spawn spiders instead of Flies.


  • Pestilence is also known as the rider of the white horse, Conquest, another enemy in The Binding of Isaac: Rebirth.
  • Pestilence is mentioned in Revelation 6:1-2^.
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