Diabolical Diseases

I N WORLDS WHERE MANY

diseases can be cured with a single

spell or temple visit, more tenacious

and pernicious illnesses are bound to

fill that gap.

Each of the following diseases has

one or more levels of infection. Infec-

tion levels can be lost through ongoing

treatment or the use of magic: a lesser

restoration spell reduces a disease’s

severity by 1 infection level, a use of

a paladin’s Lay on Hands reduces a

disease’s severity by 1 infection level,

and greater restoration decreases a

reduce’s severity by 3 infection levels.

WRITING Tyler Omichinski
None of these methods can fully cure COLOR ART Herman Lau
EDITING Mike Myler
these diseases, but when used before a LAYOUT Frank Michienzi

test to increase an infection level they

grant a creature advantage.

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 TABLE: FAESIC POX
Faesic Pox Infection
A strange illness from various fey planes, the faesic Level Symptoms
pox is not particularly virulent but can cause intense
The infected creature has an onset of
distress for the infected. Still, allowing the plant sneezing, runny nose, and watering
growths that it causes to spread far enough might as eyes as though experiencing an allergic
well lead to death. reaction. The infected creature has
When a non-plant creature consumes food or drink 1: Initial disadvantage on Dexterity (Stealth) rolls.
At the end of each long rest, the
infected with faesic pox (often from the fey realms), it infected creature makes a DC 18
must make a DC 13 Wisdom saving throw or become Constitution saving throw or its
infected. infection level increases by 1.
Symptoms manifest 1d6 days after being infected
Previous symptoms end. All manner
and depend on the infection’s level (see Table: Faesic of flowers grow from the infected
Pox). Intelligence loss from this disease cannot be creature’s body and it gains resistance
recovered until an infected creature is cured (a cured to poison.
2: Moderate
At the end of each long rest, the
creature regains 1d4 Intelligence at the end of each
infected creature makes a DC 16
long rest). Constitution saving throw or its
This disease can be reversed up until a creature infection level increases by 1.
reaches infection level 4. After a creature has stayed
All of the infected creature’s hair,
at infection level 1 for two weeks or has taken at least feathers, and fur are replaced with
30 fire damage that remains unhealed until finishing plant life. The infected creature gains
a long rest, it is cured of the disease. immunity to poison damage and cannot
be poisoned, but gains vulnerability to
3: Serious
fire damage and necrotic damage.
At the end of each long rest, the
infected creature makes a DC 14
Constitution saving throw or its
infection level increases by 1.

Parts of the infected creature’s body

gradually become plant matter. At
the end of each long rest, the infected
creature makes a DC 12 Constitution
4: Critical saving throw or its Intelligence is
reduced by 1d6. The infected creature
transforms into a shambling mound if
this reduces its Intelligence to 4 or less
and it can no longer be cured.

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 TABLE: THE FLUXX
The Fluxx Infection
The fluxx originated in an undetermined outer plane Level Symptoms
and was brought to the realms material. Once this
No visible effects. At the end of each
sickness has taken hold crystalline growths spread long rest, the infected creature makes
across an infected creature until it is entirely covered. 1: Dormant
a DC 13 Constitution saving throw or
Some even speculate that those who are thought to its infection level increases by 1.
have died from the illness are still alive, paralyzed
The site of the infection (or roll 1d4
and only able to watch the surrounding world. to randomly determine which limb)
When a creature is damaged by a creature that sprouts crystalline structures. The
carries the disease, it must make a DC 14 Constitu- infected creature’s Dexterity is
2: Initial
reduced by 2. At the end of each long
tion saving throw or become infected. Alternatively, a
rest, the infected creature makes a DC
creature that eats meat from a creature that carries the 14 Constitution saving throw or its
disease must succeed on a DC 17 Constitution saving infection level increases by 1.
throw or become infected.
The entire limb sprouts crystalline
Symptoms manifest 1d4 days after becoming structures that increase the infected
infected on the Material Plane or when an infected creature’s unarmed strike damage to
creature enters the Material Plane, and depend on the 1d6. The infected creature’s Dexterity
3: Moderate
is reduced by 2. At the end of each long
infection’s level (see Table: The Fluxx). Dexterity loss
rest, the infected creature makes a DC
from this disease is cumulative and cannot be recov- 15 Constitution saving throw or its
ered until a cured creature’s affected limb is restored infection level increases by 1.
(a cured creature regains 1d4 Dexterity at the end of
Crystalline growths spread across the
each long rest). infected creature’s body, increasing its
There is no way to reverse the effects of the fluxx Armor Class by 1. The infected creature’s
on a creature after it reaches infection level 2 and any 4: Serious
Dexterity is reduced by 1d4. At the end
affected limbs must be amputated before this disease of each long rest, the infected creature
makes a DC 16 Constitution saving
can be cured. After a creature has stayed at infection throw or its infection level increases
level 1 for a week, it is cured of the fluxx. by 1.

The infected creature becomes

covered by crystalline growths and its
unarmed strike damage increases to
1d8. The infected creature’s Dexterity
is reduced by 4. At the end of each
5: Critical long rest, the infected creature makes
a DC 17 Constitution saving throw or
its Dexterity is reduced by 1d4. The
infected creature dies if this reduces
its Dexterity to 0 as it completely
transforms into crystal.

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 TABLE: MYCOLOGICAL WILDFIRE
Mycological Wildfire Infection
Spoken of in hushed tones among those who know of Level Symptoms
it, survivors of this disease claim that they are able to
No apparent signs. At the end of each
hear and talk to the fungus, either through dreams, long rest, the infected creature makes
as whispers, or in normal conversations. Certain cults 1: Initial
a DC 15 Constitution saving throw or
are known to cultivate mycological wildfire in careful its infection level increases by 1.
efforts as the infection tends to make those it infects
The infected creature starts to lose its
stronger even as it takes them over. sense of smell but there are no other
Sentient Sickness. The most disturbing aspect apparent signs. At the end of each short
2: Dormant
of mycological wildfire is how it takes control of rest, the infected creature makes a
DC 15 Constitution saving throw or its
its victims, forcing them to act towards strange
infection level increases by 1.
goals and to undertake nonsensical tasks. Many
of the diseased descend far below the surface — The infected creature becomes slightly
clumsy. When it rolls a natural 1 on a
never to be seen again.
Strength or Dexterity check, it stumbles
When a creature is exposed to mycological wildfire 3: Tactile and falls prone. At the end of each long
spores, either through inhalation or consumption, rest, the infected creature makes a
it must make a Constitution saving throw (DC 10 + DC 15 Constitution saving throw or its
infection level increases by 1.
1 per previous exposure in the last day) or become
infected. Undead can be carriers of mycological wild- The infected creature sprouts small
fire and cause infection with their natural weapons, fungal growths along its body in
but are immune to its effects. The ability scores places that can easily be hidden
beneath clothing, two of its ability
increased by this disease are chosen by the GM, and scores increase by 1, and whenever
creatures immune to the charmed condition can still it sleeps there’s a 50% chance that it
be compelled by mycological wildfire. dreams of mushrooms.
After a creature has stayed at infection level 1 for In addition, whenever the infected
4: Serious creature takes 15 or more bludgeoning,
two weeks it is cured of the disease. piercing, or slashing damage it releases
a cloud of infectious spores in a 5-foot
radius. The infected creature is immune
to its own spores.
At the end of each long rest, the
infected creature makes a DC 15
Constitution saving throw or its
infection level increases by 1.

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 The infected creature’s fungal growths This disease can be reversed up until a creature
spread but can be hidden by a robe reaches infection level 4. After a creature has taken
(though the hood must stay up to
35 poison damage within 24 hours, when it finishes
prevent others from seeing the glassy
eyes or growths creeping up its neck), a long rest it can make a DC 14 Constitution saving
two of its ability scores increase by 1, throw to reduce its infection level 1, curing itself if it
and whenever it takes 5 or more damage is at infection level 1.
it releases a cloud of infectious spores in
a 10-foot radius. The infected creature is
immune to its own spores. TABLE: WYRM POX
In addition, once per day the disease Infection
can force the infected creature to Level Symptoms
make a DC 15 Wisdom saving throw.
5: Loud
On a failure, the disease takes over the There are a number of sand-sized eggs
infected creature for 1d6+5 rounds. in the infected creature’s solid waste
This functions as the dominate monster 1: Initial
and after 1 week its infection level
spell, except the infected creature increases by 1.
repeats the saving throw at the end of
each of its turns, ending the effect on a The sand-sized eggs still in the
success. When the disease takes control infected creature’s body hatch and the
for 1 minute or longer, it can do so again wyrmlings begin to feed. The infected
2: Hatching
within the next 24 hours. creature must consume twice as much
At the end of each long rest, the food as normal and after 1 week its
infected creature makes a DC 13 infection level increases by 1.
Constitution saving throw or its
infection level increases by 1. Painful and translucent boils spread
across the infected creature’s body,
The infected creature becomes covered miniscule worm-like shapes writhing
in fungal growths that hijack its body, inside. Whenever the infected creature
and it is unable to retain its own mind regains hit points there is a 50% chance
for any significant amount of time. At that it regains half as many hit points
6: Critical
the end of each long rest, the infected as normal, and when it takes 10 or
creature makes a DC 16 Wisdom saving more piercing or slashing damage
3: Pupation
throw or the disease takes over its body one of the boils is popped causing the
until it finishes a long rest. infected creature must make a DC 15
Constitution saving throw. On a failure,
it is poisoned for 1 hour. After a number
Wyrm Pox of boils equal to the creature’s hit dice
have been popped, its infection level is
Believed to originally be a parasite on various draconic decreased by 1. Otherwise after 1 week
species, wyrm pox is a plague feared for both what it its infection level increases by 1.
does to those it afflicts and what comes afterward. Small The boils across the infected creature’s
wyrmlings are born within the flesh of the infected, body become fist-sized with wriggling
slowly eating and growing until they create boils on creatures as big as a finger occasionally
their host’s body that then burst, causing the wyrmlings swimming up to peer out at the wider
world. Whenever the infected creature
to move on to the next phase of their life cycle. takes damage, it must make a DC 15
When a creature breathes in a wyrmling egg (each Constitution saving throw or 1d6 pox
4: Emergence
is about the size of a speck of dust), it must make a wyrmlings emerge from boils in its
DC 11 Constitution saving throw or become infected. body. The Tiny creatures attack the
nearest target in a flurry of activity
Celestials, constructs, elementals, fiends, plants, and before retreating when damaged.
undead are immune to this disease. After 15 or more pox wyrmlings have
emerged from the infected creature, it
is cured of this disease.

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POX WYRMLING TABLE: NECROTIZING PLAGUE
TINY DRAGON, CHAOTIC NEUTRAL Initial Infection: There is some redness around the
Armor Class 13 (natural armor) bite that caused the infection, general drowsiness,
Hit Points 15 (6d4) and may have some aches and pains.
1
Speed 20 ft., burrow 10 ft., climb 20 ft., fly 30 ft. Each day after the third day in the Initial Infection
state, make a DC 12 Constitution Saving throw. On
STR DEX CON INT WIS CHA a failure gain an Infection level.
4 (–3) 13 (+1) 10 (+0) 8 (–1) 11 (+0) 12 (+1)
Saving Throws Dex +3, Con +2, Wis +2, Cha +3 Moderate Infection: The sufferers flesh begins
to turn necrotic and dead across their body, skin
Skills Perception +4, Stealth +5
begins to slough off, revealing putrid musculature
Senses darkvision 30 ft., passive Perception 14 underneath. Despite this, the subject is able to
Challenge ½ (100 XP) continue to operate largely as normal.
Pack Tactics. The pox wyrmling has advantage on an Sufferer gains:
attack roll against a creature if at least one of the • Resistance to Necrotic Damage,
dragon’s allies is within 5 feet of the creature and the Poison Damage
2
ally isn’t incapacitated. • Weakness to Fire Damage, Radiant Damage
ACTIONS +1 AC (natural armor from being half dead)
Multiattack. The pox wyrmling makes one bite attack • Minus 2 Intelligence (does not recover
and one claw attack. from revivify)
Bite. Melee Weapon Attack: +3 to hit, reach 5 ft., one • Each time the sufferer falls below half their
maximum hit points, they must make a DC
target. Hit: 3 (1d4+1) piercing damage.
14 Con Saving throw. On a failure, they gain
Claws. Melee Weapon Attack: +3 to hit, reach 5 ft., one an infection level.
target. Hit: 3 (1d4+1) slashing damage
Critical Infection: The sufferer is more dead
than alive at this point. Most of their flesh is

Necrotizing Plague dead, their skin has all fallen off, their internal
organs barely function. Few can meet their gaze
A disease that rarely causes outbreaks without some at this point as their eyes are a terrifying piercing
other force tipping the scales. This plague is relatively bloodshot-gaze.
slow moving, and it can last indefinitely in those who Sufferer:
have been subjected to it. • Can no longer consume potions, food,
If a creature has been bit by another creature with drink, etc
the Necrotizing Plague, they must make a DC 18 3 • Can no longer be healed by magical spells
Constitution Saving Throw or be infected. Constructs • Creature now counts as Undead
are immune to Necrotizing Plague. • Gains Resistance to Slashing and
Any damage that is done by Necrotizing Plague is Piercing damage
permanent, but all other effects are contingent upon • Gains Immunity to Necrotic Damage,
the creature’s infection level. Necrotizing Plague can Poison Damage
be managed by keeping the Infection Level down, but • Gains Weakness to Fire Damage,
Radiant Damage
it can only be cured by the Revivify Spell, which can
cure it from any level. • Minus 2 Charisma, Minus 2 Intelligence
e (does not recover from Revivify)

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