GET

SICK
T here’s only one time it’s

fun to get sick: game time.

Tabletop roleplaying games have

or sample illnesses. This article

provides guidance for creating your

own diseases and examples to use

an established tradition of giving in your game.

player characters nasty, wonderful

illnesses. Unfortunately, the Fifth writing James Introcaso

color art Xanditz
Edition core rulebooks have little in editing James J. Haeck
layout Eric Life-Putnam
the way of disease design guidelines

EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game

Creating Your Own
Diseases
First, decide if the illness you are creating is
mundane or supernatural. This choice will inform
the disease’s three components: transmission
method, symptoms, and cure. Mundane compo­
nents mimic those found in the real world, and
supernatural components are the kind that can
only happen in a fantasy game. A supernatural
disease can have mundane components, but it
must have at least one supernatural component.
Transmission Method
A transmission method is the way a disease infects
creatures. Mundane diseases can be airborne,
foodborne, contact, and intimate. Contact diseases
are spread by interacting with other creatures via
skin to skin contact and intimate diseases require
more than a handshake (like drinking from the
same glass or kissing). Supernatural transmission
methods include spells, attacks of certain monsters,
alchemical products, and exposure to foreign
planes.
When a creature is exposed to a disease’s
transmission method, it is allowed a saving throw
to resist being infected. Most diseases require a
Constitution saving throw, but some supernatural
diseases which affect the mind could require
an Intelligence, Wisdom, or Charisma saving
throw. Marginally contagious diseases require a
DC 10–11 save, moderately contagious diseases
require DC 12–15, and highly contagious diseases
require DC 16–20. If a disease has a transmission
method which guarantees a lot of exposure, such
as airborne, consider giving its saving throw a
lower DC so all your PCs don’t take a week off from
adventuring to fight the flu instead of orcs.
Note any specific creatures who might be
immune to the disease. Immunity could be random
and unexplained in very rare cases. In areas where
a disease is most prevalent, some creatures have
developed an immunity over the ages, while others
carry the disease, but never experience its ill effects.
Part of a disease’s transmission method is an
incubation period. Most diseases need time to
infect a target before symptoms appear, usually a
few hours to a few weeks. Keep incubation periods
shorter than a month, otherwise you might forget
a PC is infected.
Symptoms
Most diseases have multiple symptoms which
increase in severity if untreated. Mundane diseases
have typical symptoms like coughing, sneezing,
and vomiting while supernatural diseases have
otherworldly symptoms like limbs turning into
jelly or growing tentacles.
Assign symptoms a mechanical effect. A disease
which causes a creature to vomit uncontrollably
imposes levels of exhaustion, representing the
creature’s growing dehydration. Mechanical effects
for diseases include increased exhaustion levels,
reduced hit point recovery, penalties to attack rolls,
saving throws, ability checks, and AC, conditions,
slowed movement, spell effects, and madness.
Some diseases have deceptive symptoms at first
which actually give creatures a mechanical bonus
before imposing a penalty.
Think about the disease’s end effect when
creating symptoms. Death, indefinite madness,
a permanent condition such as blindness, or
transforming into another creature entirely could
be the final result of an illness. Let that end effect
inform the disease’s symptoms. For example, a
supernatural disease that transforms a creature
into an ooze might first reduce the creature’s
movement and penalize its Dexterity saving throws
as it becomes more lethargic and oozelike.

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Get Sick  |  EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game
Cure
Most diseases play out in a series of saving throws.
With every success the symptoms get better, but
with every failure they worsen. To encourage
teamwork and camaraderie, a GM may grant a PC
advantage on a saving throw if one of their allies
succeeds on a DC 15 Wisdom (Medicine) check to
care for the infected character during a long rest.
Diseases sometimes have another cure beyond
this series of saving throws. Spells, alchemical
treatments, environmental cures (like bathing in a
specific spring), special creatures (the touch of an
angel), or a combination of these could cure disease
even after a creature has entered the disease’s end
state.
Sample Diseases
Bottle Fever
Mundane Disease
Drinking putrid ale, wine, or liquor can mean
more than a hangover. Creatures who catch bottle
fever feel drunk even when they haven’t had any
alcohol, because the yeast from a previous bad
drink sticks to the walls of their stomachs and
continues to ferment.
A creature who drinks rancid alcohol must
succeed on a DC 12 Constitution saving throw or
contract bottle fever. The first symptoms of bottle
fever begin to show in 1d10 hours. An infected
creature gives off a strong alcoholic odor. When the
creature performs a physically exerting act, like
climbing a wall or fighting, it must succeed a DC 10
Constitution saving throw or become poisoned for
1 hour. If the creature succeeds on the saving throw,
it does not need to make another saving throw for
this effect for 1 hour.
At the end of each long rest, an infected creature
must make a DC 12 Constitution saving throw. If
the creature fails three of these saving throws, the
yeast become embedded in its stomach and the
disease can only be cured by drinking a potion of
supreme healing. If the creature succeeds on three
of these saving throws, the disease is cured.
EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game  |  Get Sick
Demonic Plague
Supernatural Disease
Yellow-green plague shrubs grow in the Abyss.
The plants are harmless to demons, but when their
spores are inhaled by a non- demon, a piece of the
Abyss is planted in the victim’s body. Demons have
been known to craft spore bombs to spread chaos
amongst enemies, even among devils.
Creatures who breathe in the spores must
succeed on a DC 15 Constitution saving throw or
contract demonic plague. Within 1d4 hours of
contracting the disease an infected creature grows
physically stronger, but begins to lose its mind. The
creature’s Strength score is raised to 19 unless it
already has a higher score and it gains advantage
on all Strength checks and saving throws. The
creature’s Intelligence score drops 1d6 points. The
creature’s Intelligence score cannot fall below 2 as
a result of this disease.
At the end of each long rest, an infected creature
must make a DC 15 Constitution saving throw.
On a failed save, the creature’s Intelligence score
is decreased by 1d6 points. If the creature’s
Intelligence score falls to 2, it desires only to kill
and eat creatures of its type and only a greater
restoration spell cast by a celestial or fiend can
cure the creature. If the creature is a PC the GM
takes control of the character until it is cured. On
a successful save, the creature regains 1 point of
Intelligence. If the creature’s Intelligence score
returns to normal the disease is cured.
Itching Insides
Mundane Disease
Itching insides is a respiratory disease surface-
dwelling creatures can catch in damp underground
areas or by coming into contact with another
creature infected with the disease. Creatures who
normally live underground, like drow and dwarves,
are immune to itching insides.
A surface-dwelling creature who has spent a
continuous week in a damp underground area or
who has come within 10 feet of an infected creature
must succeed a DC 15 Constitution saving throw
or contract itching insides. The first symptoms,
coughing and feeling itchy inside the lungs, appear
in 1d4 days.
As the disease progresses, an infected creature
begins to cough up a black mucus and the itching
in its lungs turn to burning. The creature gains
one level of exhaustion and whenever it performs
a physically exerting act, like casting a spell or
taking the Dash action, it must succeed a DC 11
Constitution saving throw or fall prone as it is
overwhelmed by shooting pain in its lungs.
At the end of each long rest, an infected creature
must make a DC 15 Constitution saving throw.
On a failed save, the creature gains one level of
exhaustion and the DC to save against falling prone
from pain during physical exertion increases by
1. On a successful save, the creature’s exhaustion
decreases by one level and the DC to save against
falling prone from pain during physical exertion
decreases by 1. If a successful saving throw reduces
the infected creature’s level of exhaustion below 1,
the disease is cured.
Ooze Decay
Supernatural Disease
Humanoids and beasts contract ooze decay by
drinking water which an ochre jelly has touched
within the past 24 hours. The disease slowly turns
its victims more ooze-like until they make complete
transformations into ochre jellies.
Any humanoid or beast who drinks tainted water
must succeed on a DC 13 Constitution saving
throw or contract ooze decay. In 1d4 days the first
symptoms begin to appear. An infected creature
feels lethargic and hungry. Its skin takes on a pale
yellow hue which darkens as the disease progresses.
The creature’s base walking speed is reduced by 5
feet and it has disadvantage on all Dexterity checks
and saving throws.
At the end of each long rest, an infected creature
must make a DC 13 Constitution saving throw. On a
failed save, the creature’s 5 feet. When the creature’s
walking speed becomes 10 feet, it transforms into
an ochre jelly and if the creature is a PC, the GM
takes control of the character. A transformed
creature can only be returned to humanoid form
Get Sick  |  EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game
by a wish spell. On a successful save, the creature
regains 5 feet of its base walking speed. When
the creature’s base speed returns to normal, the
disease is cured.
Aberrant Touch
Supernatural Disease
Aberrant touch is a terrifying disease of the
mind which drives creatures mad. Aberrations
can carry and transmit this disease, but it has no
ill effects on their minds. This disease is contracted
by communicating telepathically with an infected
creature.
A creature who exposes its mind through
telepathic communication with another creature
must succeed on a DC 15 Intelligence saving throw
or contract aberrant touch. In 1d4 hours, the first
symptoms begin to appear. An infected creature
can only speak and understand Deep Speech,
bleeds from its ears, and is covered in sores that
ooze lime green pus. The creature also gains a
random form of long-term ma dness, as described
in the GM’s core rulebook.
At the end of each long rest, an infected creature
must make a DC 15 Intelligence saving throw. On a
failure the creature gains a random form of long-
term madness. After three failures, the creature
gains a random form of indefinite madness
which can only be cured by eating the brain of an
intelligent aberration. The disease is cured after
three successes.
Walking Rot
Mundane Disease
Walking rot is an urban plague feared by
city dwellers everywhere. It is a festering skin
disease which causes flesh to fall off an infected
creature’s bones, is highly infectious, and has
a long incubation period. By the time a victim
starts showing signs of walking rot, that person
has already infected many others. Elves, gnomes,
and fey are immune to this disease, though no one
knows why. As a result, communities experiencing
an outbreak of the disease seek out those creatures
for aid.
 A creature who has touched
another infected with the
disease must succeed on a DC
15 Constitution saving throw
or contract walking rot. If
a person who dies while
infected is raised as an undead
creature, they are able to pass
walking rot on to anyone
who touches them. The first
symptoms take 1d4 weeks to
appear. An infected creature’s
skin takes on a bright red
rash which bleeds when
touched. The creature’s hit
point maximum is reduced
by 1d10. As the disease
progresses, the skin turns
black and the creature’s flesh
begins to fall off in small,
rotten pieces.
At the end of each long rest,
an infected creature must
make a DC 15 Constitution
saving throw. On a failed
save the creature’s hit point
maximum is reduced by
1d10. Once the creature’s
hit point maximum is half
normal, the creature’s speed
is halved. Once the creature’s hit
point maximum is a quarter of what it
would be without the disease, the creature
suffers disadvantage on all attack rolls and
saving throws. Once the creature’s hit point
maximum is reduced to 0, the creature dies. On a increases by 1. If the creature’s hit point maximum
successful save, the creature’s hit point maximum returns to normal, the disease is cured.e

EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game  |  Get Sick
diabolical
diseases
I n worlds where

diseases can be cured with a

single spell or temple visit, more

many

tenacious and pernicious illnesses

are bound to fill that gap.

Each of the following diseases has one or

more levels of infection. Infection 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. None of these methods can
fully cure these diseases, but when used before
a test to increase an infection level they grant a
creature advantage.

writing Tyler Omichinski

color art Herman Lau
editing Mike Myler
layout Eric Life-Putnam

Diabolical Diseases  |  EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game
Faesic Pox
A strange illness from various fey planes, the
faesic pox is not particularly virulent but can cause
intense distress for the infected. Still, allowing the
plant growths that it causes to spread far enough
might as well lead to death.
When a non-plant creature consumes food or
drink infected with faesic pox (often from the fey
realms), it must make a DC 13 Wisdom saving throw
or become infected.
Symptoms manifest 1d6 days after being infected
and depend on the infection’s level (see Table:
Faesic Pox). Intelligence loss from this disease
cannot be recovered until an infected creature is
cured (a cured creature regains 1d4 Intelligence at
the end of each long rest).
This disease can be reversed up until a creature
reaches infection level 4. After a creature has stayed
at infection level 1 for two weeks or has taken at
least 30 fire damage that remains unhealed until
finishing a long rest, it is cured of the disease.
EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game  |  Diabolical Diseases
TABLE: FAESIC POX
1: Initial The infected creature has an onset of
sneezing, runny nose, and watering eyes as
though experiencing an allergic reaction.
The infected creature has disadvantage
on Dexterity (Stealth) rolls. At the end of
each long rest, the infected creature makes
a DC 18 Constitution saving throw or its
infection level increases by 1.
2: Moderate Previous symptoms end. All manner of
flowers grow from the infected creature’s
body and it gains resistance to poison.
At the end of each long rest, the infected
creature makes a DC 16 Constitution saving
throw or its infection level increases by 1.
3: Serious All of the infected creature’s hair, feathers,
and fur are replaced with plant life. The
infected creature gains immunity to poison
damage and cannot be poisoned, but gains
vulnerability to 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.
4: Critical 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 saving throw or
its Intelligence is reduced by 1d6. If this loss
reduces the infected creature’s Intelligence
to 4 or less, the infected creature transforms
into a shambling mound, and it can no
longer be cured.
The Fluxx
The fluxx originated in an undetermined outer
plane and was brought to the realms material.
Once this sickness has taken hold crystalline
growths spread across an infected creature until it
is entirely covered. Some even speculate that those
who are thought to have died from the illness are
still alive, paralyzed and only able to watch the
surrounding world.
When a creature is damaged by a creature
that carries the disease, it must make a DC 14
Constitution saving throw or become infected.
Alternatively, a creature that eats meat from a
creature that carries the disease must succeed
on a DC 17 Constitution saving throw or become
infected.
Symptoms manifest 1d4 days after becoming
infected on the Material Plane or when an infected
creature enters the Material Plane, and depend on
the infection’s level (see Table: The Fluxx). Dexterity
loss from this disease is cumulative and cannot be
recovered until a cured creature’s affected limb is
restored (a cured creature regains 1d4 Dexterity at
the end of each long rest).
There is no way to reverse the effects of the fluxx
on a creature after it reaches infection level 2 and
any affected limbs must be amputated before this
disease can be cured. After a creature has stayed at
infection level 1 for a week, it is cured of the fluxx.
Diabolical Diseases  |  EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game
TABLE: THE FLUXX
1: Dormant No visible effects. At the end of each long
rest, the infected creature makes a DC 13
Constitution saving throw or its infection
level increases by 1.
2: Initial The site of the infection (or roll 1d4 to
randomly determine which limb) sprouts
crystalline structures. The infected
creature’s Dexterity is reduced by 2. At the
end of each long rest, the infected creature
makes a DC 14 Constitution saving throw or
its infection level increases by 1.
3: Moderate The entire limb sprouts crystalline
structures that increase the infected
creature’s unarmed strike damage to
1d6. The infected creature’s Dexterity
is reduced by 2. At the end of each long
rest, the infected creature makes a DC 15
Constitution saving throw or its infection
level increases by 1.
4: Serious Crystalline growths spread across the
infected creature’s body, increasing its
Armor Class by 1. The infected creature’s
Dexterity is reduced by 1d4. At the end of
each long rest, the infected creature makes
a DC 16 Constitution saving throw or its
infection level increases by 1.
5: Critical 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 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.
Mycological Wildfire
Spoken of in hushed tones among those who know
of it, survivors of this disease claim that they are
able to hear and talk to fungi through dreams, as
whispers, or in normal conversations. Certain
cults are known to cultivate mycological wildfire in
careful efforts as the infection tends to make those
it infects stronger even as it takes them over.
Sentient Sickness. The most disturbing aspect of
mycological wildfire is how it forces victims to act
toward strange goals and undertake nonsensical
tasks. Many of the diseased descend far below the
surface—never to be seen again.
When a creature is exposed to mycological
wildfire spores, either through inhalation or
consumption, it must make a Constitution saving
throw (DC 10 + 1 per previous exposure in the last
day) or become infected. Undead can be carriers of
mycological wildfire and cause infection with their
natural weapons, but are immune to its effects. The
ability scores increased by this disease are chosen
by the GM, and creatures immune to the charmed
condition can still be compelled by mycological
wildfire.
After a creature has stayed at infection level 1 for
two weeks it is cured of the disease.
TABLE: MYCOLOGICAL WILDFIRE
1: Initial No apparent signs. At the end of each long
rest, the infected creature makes a DC 15
Constitution saving throw or its infection
level increases by 1.
2: Dormant The infected creature starts to lose its
sense of smell but there are no other
apparent signs. At the end of each short
rest, the infected creature makes a DC 15
Constitution saving throw or its infection
level increases by 1.
3: Tactile The infected creature becomes slightly
clumsy. When it rolls a natural 1 on a
Strength or Dexterity check, it stumbles
and falls prone. At the end of each long
rest, the infected creature makes a DC 15
Constitution saving throw or its infection
level increases by 1.
EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game  |  Diabolical Diseases
4: Serious The infected creature sprouts fungal growths
along its body in places that can be hidden
beneath clothing, two of its ability scores
increase by 1, and whenever it sleeps there’s
a 50% chance that it dreams of mushrooms.
  In addition, whenever the infected
creature takes 15 or more bludgeoning,
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.
5: Loud The infected creature’s fungal growths
spread but can be hidden by a robe (though
the hood must stay up to prevent others
from seeing the glassy eyes or growths
creeping up its neck), two of its ability
scores increase by 1, and whenever it takes
5 or more damage it releases a cloud of
infectious spores in a 10-foot radius. The
infected creature is immune to its own
spores. In addition, once per day the disease
can force the infected creature to make a
DC 15 Wisdom saving throw. On a failure,
the disease takes over the infected creature
for 1d6+5 rounds. This functions as the
dominate monster spell, except the infected
creature repeats the saving throw at the end
of each of its turns, ending the effect on a
success. When the disease takes control for
1 minute or longer, it can do so again within
the next 24 hours. At the end of each long
rest, the infected creature makes a DC 13
Constitution saving throw or its infection
level increases by 1.
6: Critical The infected creature becomes covered in
fungal growths that hijack its body, and
it is unable to retain its own mind for any
significant amount of time. At the end of
each long rest, the infected creature makes
a DC 16 Wisdom saving throw or the disease
takes over its body until it finishes a long
rest.
Wyrm Pox
Believed to originally be a parasite on various
draconic species, wyrm pox is a plague feared
for both what it does to those it afflicts and what
comes afterward. Small wyrmlings are born within
the flesh of the infected, slowly eating and growing
until they create boils on their host’s body that then
burst, causing the wyrmlings to move on to the
next phase of their life cycle.
When a creature breathes in a wyrmling egg
(each is about the size of a speck of dust), it must
make a DC 11 Constitution saving throw or become
infected. Celestials, constructs, elementals, fiends,
plants, and undead are immune to this disease.
This disease can be reversed up until a creature
reaches infection level 4. After a creature has taken
35 poison damage within 24 hours, when it finishes
a long rest it can make a DC 14 Constitution saving
throw to reduce its infection level 1, curing itself if
it is at infection level 1.
Pox Wyrmling
Tiny dragon, chaotic neutral
Armor Class 13 (natural armor)
Hit Points 15 (6d4)
Speed 20 ft., burrow 10 ft., climb 20 ft., fly 30 ft.
STR DEX CON INT WIS CHA
4 (–3) 13 (+1) 10 (+0) 8 (–1) 11 (+0) 12 (+1)
Saving Throws Dex +3, Con +2, Wis +2, Cha +3
Skills Perception +4, Stealth +5
Senses darkvision 30 ft., passive Perception 14
Challenge ½ (100 XP)
Pack Tactics. The pox wyrmling has advantage on
an attack roll against a creature if at least one of the
dragon’s allies is within 5 feet of the creature and the
ally isn’t incapacitated.
ACTIONS
Multiattack. The pox wyrmling makes one bite attack
and one claws attack.
Bite. Melee Weapon Attack: +3 to hit, reach 5 ft., one
target. Hit: 3 (1d4+1) piercing damage.
Claws. Melee Weapon Attack: +3 to hit, reach 5 ft., one
target. Hit: 3 (1d4+1) slashing damage
Diabolical Diseases  |  EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game
TABLE: WYRM POX
1: Initial There are a number of sand-sized eggs
in the infected creature’s solid waste and
after 1 week its infection level increases
by 1.
2: Hatching The sand-sized eggs still in the infected
creature’s body hatch and the wyrmlings
begin to feed. The infected creature
must consume twice as much food as
normal and after 1 week its infection level
increases by 1.
3: Pupation Painful and translucent boils spread
across the infected creature’s body,
miniscule worm-like shapes writhing
inside. Whenever the infected creature
regains hit points there is a 50% chance
that it regains half as many hit points as
normal, and when it takes 10 or more
piercing or slashing damage one of the
boils is popped, forcing the infected
creature to make a DC 15 Constitution
saving throw. On a failure, it is poisoned
for 1 hour. After a number of boils equal to
the creature’s Hit Dice have been popped,
its infection level is decreased by 1.
Otherwise after 1 week its infection level
increases by 1.
4: Emergence The boils across the infected creature’s
body become fist-sized with wriggling
creatures as big as a finger occasionally
swimming up to peer out at the wider
world. Whenever the infected creature
takes damage, it must make a DC 15
Constitution saving throw or 1d6 pox
wyrmlings emerge from boils in its body.
The Tiny creatures attack the nearest
target in a flurry of activity before
retreating when damaged. After 15 or
more pox wyrmlings have emerged from
the infected creature, it is cured of this
disease.
Necrotizing Plague
A disease that rarely causes outbreaks without
some other force tipping the scales. This plague is
relatively slow moving, and it can last indefinitely
in those who have been subjected to it.
If a creature has been bit by another creature
with the necrotizing plague, they must make a dc 18
constitution saving throw or be infected. constructs
are immune to necrotizing plague.
Any damage that is done by Necrotizing Plague
is permanent, but all other effects are contingent
upon the creature’s infection level. Necrotizing
Plague can be managed by keeping the Infection
level down, but it can only be cured by the revivify
Spell, which can cure it from any level.
e
EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game  |  Diabolical Diseases
TABLE: NECROTIZING PLAGUE
1: Initial There is some redness around the bite that
caused the infection, general drowsiness,
and possibly aches and pains. Each day
after the third day in the Initial Infection
state, make a DC 12 Constitution saving
throw. On a failure gain an Infection level.
2: Moderate The sufferer’s flesh begins to turn necrotic
and dead across their body, skin begins to
slough off, revealing putrid musculature
underneath. Despite this, the subject is
able to continue to operate largely as
normal. Each time the sufferer falls below
half their maximum hit points, they must
make a DC 14 Constitution saving throw. On
a failure, they gain an infection level. The
sufferer gains:
• Resistance to necrotic and poison
damage
• Vulnerability to fire and radiant damage
• +1 AC (natural armor; necrotic tissues)
• –2 Intelligence (this loss cannot be
recovered with revivify)
3: Critical The sufferer is more dead than alive at this
point. Most of their flesh is dead, their skin
has all fallen off, their internal organs barely
function. Few can meet their gaze at this
point as their eyes are a terrifying piercing
bloodshot-gaze. The sufferer:
• Can no longer consume potions, food,
drink, etc
• Can no longer be healed by spells
• Creature now counts as undead
• Gains resistance to slashing and piercing
damage
• Gains immunity to necrotic and poison
damage
• Gains weakness to fire and radiant
damage
• –2 Charisma, –2 Intelligence (this loss
cannot be recovered with revivify)
PLANAR
diseases
G Ms know that hitting

characters hard can make

players jump, but to truly get

them quaking try infecting

them with something! Fantasy

heroes are well‐equipped to

deal with damage dealt by

monsters, fireballs, or falling

rocks. Recovering hit points is

common and straightforward in

most games. More importantly,

getting hit isn’t usually dangerous

in and of itself—only reaching 0

writing Eran Aviram
color art Rachel Maduro hit points has a real and visceral
editing Mike Myler
layout Eric Life-Putnam impact at the table.

Planar Diseases  |  EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game
Diseases tend to be unpleasant surprises and
present a different kind of challenge, sometimes
changing adventurers before a malady has run its
course. This article takes that concept a step further
with diseases from beyond the world of mortals.
Most have debilitating effects that might sometimes
have potential use, but more importantly they
shake things around and make the party reconsider
the dangers they might face in the future.
Note that just like planar travel itself, these
diseases are more suited for higher‐level PCs.
While some can have effects that are relevant
during combat most are designed with a wider‐
scope in mind, to be used as fun story elements
or as a reminder that any dealing with the
greater multiverse is dangerous and strange. Also
remember that these ailments are not the result of
bacteria or virus infection—but then again, who’s to
say the germ theory of disease is true in all settings?
Planar Diseases
Adverse Ascension
Being exposed to too much unfiltered godly glory
is deadly to mortals, the simple matter of their
flesh and their paltry souls too small to contain
such radiance. The most common way to contract
adverse ascension is by use of the commune spell,
becoming afflicted once every time the caster does
not receive an answer. A creature that takes radiant
damage equal to triple its total Hit Dice from a
celestial source can also cause affliction, but only if
its alignment or beliefs are the same as those of the
creature inflicting damage. For example, a lawful
good paladin of 7th level who takes 21 or more
damage from a planetar’s flame strike may become
infected with adverse ascension.
A creature overexposed to the divine must make a
DC 15 Wisdom saving throw or become infected with
adverse ascension. In the first phase, the infected
creature’s dreams and daydreams start featuring
more of the deity’s aspects and iconography.
After 1d2+1 days of the disease’s first stage, the
infected creature must make a DC 12 Charisma
EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game  |  Planar Diseases
saving throw or proceed to the second stage of
infection, its alignment shifting one step toward
the deity whose power it is infused with (or the
god worshiped by the creature that caused the
infection). On a success, the creature recovers fully.
At the end of each long rest, an infected creature
must make a Charisma saving throw against a DC
determined by infection stage (first stage DC 12,
second stage DC 13, third stage DC 14). The saving
throw is made with disadvantage if within the last
24 hours the infected creature witnessed divine
spellcasting by any follower of the same deity as
the one it is being drawn to.
On a success while suffering from the second
or third stage of infection, the infected creature
regresses to the previous stage of infection. On
a failure while suffering from the second stage
of infection, the infected creature gains the
ideal “All must know how great my deity is.” This
can manifest in many ways, such as muttered
whispered scriptures, or as proudly trying to
convert everyone around, depending on the person.
The infected creature begins to show a miraculous
understanding of the Outer Planes that gives it
advantage on Intelligence (Religion) checks. An
infected creature that fails a second saving throw
progresses to the third stage of adverse ascension.
On a failure while suffering from the third stage
of infection, the infected creature can cast shield of
faith once between rests. For the spell’s duration,
the infected creature begins to gently fade into the
Astral Plane as it is drawn to the divine. At the start
of each of its turns, the infected creature makes
death saving throws as if dying. The character still
acts on its turn as normal, but after three failures,
the infected creature dematerializes into the
heavens, never to be seen again. Other creatures
can use the Help action to grant the infected
creature advantage on these saves by speaking
encouraging words to it.
After a priest of the same or a similar faith has
spent 7 days in one‐on‐one theology seminars with
the infected creature, it makes a DC 12 Charisma
saving throw, completely recovering from the
disease on a success.
Fractured Rift Disorder
Every being is tied to its native plane, both in terms
of the realm’s physical laws and the dimension’s
place in the multiverse. On rare occasions
that connection can weaken, perhaps even be
severed. Frequent travel beyond the Inner and
Outer Planes dilutes a soul’s tether to its original
plane of existence. Spells such as plane shift and
well‐made portals are generally safe, allowing
for a smooth transition between dimensions, but
journeying by other means can have ill effects.
Whenever a creature travels between planes using
a naturally occurring portal or dangerous magical
item (like a well of many worlds), it must make a
DC 15 Constitution saving throw. On a failure, it is
infected with fractured rift disorder.
Whenever the infected creature gains a level of
exhaustion, its connection to the Material Plane is
tested. The character makes a DC 12 Constitution
saving throw or is teleported 1d20 feet away in a
random horizontal direction as its connection to
the here and now shifts slightly.
All of this disease’s effects manifest only while
the infected creature is on the Material Plane.
Unless treated (see below) the rift continues to
fracture and the infection worsens. At the end of
every week during which creature with a basic or
mild infection does more than rest, it must make a
Constitution saving throw. On a failure, the disease
worsens. Consult the Fractured Rift Disorder table
below. On a success, its infection reduces by one
stage (from mild to basic, or basic to recovered).
Restoration and similar magic have no effect on
fractured rift disorder since the problem can’t be
fixed with positive energy. Instead, the infected
creature needs to strengthen its connection to the
world. A druid or similarly nature‐oriented person
can diagnose the disease with a DC 18 Intelligence
(Nature) check and prescribe a long‐term treatment,
usually requiring a month of peaceful meditation
in an ancient grove or cave at the end of which the
infected creature recovers.
There are legends about living with fractured rift
disorder as well, the most popular claiming that an
old dwarven hero afflicted with it crafted a pair of
magical iron boots to keep himself grounded.
Fey Longings
The Feywild is a wondrous realm, so enchanting
that some start to long for it without ever having
been there. After any personal, intimate interaction
with a fey, a creature must make a DC 10 Wisdom
saving throw or contract this disease. Fey aware of
this danger can take special precautions to prevent
it using wards made from special plants and oils
and though most know this, few care. Characters
with fey ancestry (such as elves, gnomes, and half-
elves) are immune.
It takes 1d4 days for the symptoms of fey
longings to take hold. The infected creature

Fractured Rift Disorder

Level Cumulative Effect Worsens on…
Basic Make a DC 12 Constitution save after taking a level of exhaustion, or Failing a DC 15 Constitution saving throw
teleport 1d20 feet in a random direction. at the end of a week of adventuring.
Mild Make a DC 12 Constitution save after scoring or taking a critical hit, Failing a DC 17 Constitution saving throw
teleporting 1d20 feet in a random direction on a failure. at the end of a week of adventuring.
Severe Become ethereal (as the blink spell) whenever the infected creature Automatically worsens after several
rolls a natural 1 on a d20. Make a DC 12 Dexterity save to avoid weeks unless spent resting.
dropping held items just before the transition.
Deadly When the infected creature has been targeted by a magical effect —
that changes its form or location within the last round and it makes a
Strength check, melee attack roll, or attacks with a thrown weapon, it
must succeed on a DC 12 Constitution saving throw or be transported
to a random plane of existence.

Planar Diseases  |  EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game
begins to see fey wherever they look. At first it’s
the giggling sound of pixies just behind the next
tree, but after several days it’s not uncommon for
the delusions to include being surrounded by thick
vines, glistening psychedelic rains, or riding a
colorfully feathered frog (while in fact the infected
creature might be tangled in ropes, showered in
blood or standing on a swift‐moving boat). While
these vivid hallucinations are complete, they do
not directly lead to a character being harmed or
put into harm’s way.
When the infected creature makes an opposed
Wisdom (Insight) check or a Charisma (Deception,
Intimidation, or Persuasion) check, it must make
a DC 12 Wisdom saving throw. On a failure, the
character is charmed by one random creature
it can see. This creature cannot be an ally of the
infected creature. If there’s no viable target, the
character instead has disadvantage on attack rolls
and ability checks as it sees and tries to interact
with a world beyond the veil.
The best cure for fey longings is to bring the
infected creature to the Feywild to interact with its
denizens and environment. At the end of each day
spent in the Feywild, an infected creature makes
a DC 10 saving throw to recover from the disease.
Otherwise fey longing naturally fades after a month.
Pastrasite
This chrono‐active parasite is native to Limbo, a
result of the ever‐shifting environment in which
even time is malleable. Unfortunately, pastrasites
are drawn to the Material Plane where the rigid
temporal structure of past, present, and future
provides an excellent foundation to cling to, akin
to a caterpillar climbing up and down a tree’s bark.
They are usually contracted in places of historical
significance where they exist in a dormant state
around the time of the event itself, looking into the
future in search of visitors who have an especially
interesting past—adventurers.
There’s no certainty as to what a pastrasite looks
like as they can only be detected by their symptoms.
They never come in contact with the infected
creature itself, instead consuming the character’s
EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game  |  Planar Diseases
background, subsiding on the temporal backlash
that results when the timeline snaps back.
When a creature enters an area with pastrasites,
it must make a DC 15 Charisma saving throw as
their psyche instinctively tries to maintain their
personal timeline.
On a success, the pastrasite immediately retreats,
choosing another creature to infect. If there
are none, it can no longer maintain its temporal
existence; it disappears and leaves behind a strong
sense of imminence within its would‐be victims.
For the next several hours, these creatures all have
advantage on Intelligence checks made to recall
information.
On a failure, the creature is infected with the
disease. The pastrasite immediately destroys
several years of the infected creature’s past. If it
has one, the character loses its background and
gains a randomly determined background. This
new background is now, and always has been, the
infected creature’s past. The character is vaguely
aware of what happened with blurred recollection
of things being somehow “different” than before
becoming infected. Only spells that contact other
planes can reveal information from the infected
creature’s previous timeline. Most facts change
as little as possible to remain consistent with the
infected creature’s new past, but some friction
remains. Whenever an inconsistency between the
old and new timelines is first spoken of in front of
the character, it takes 10 (3d6) psychic damage.
The new timeline gradually settles, and the true
past can only be restored through powerful magic
such as wish or miracle. Once a pastrasite has altered
an infected creature’s timeline, although its effects
remain the creature recovers from the disease.
Spells like remove disease or features like a paladin’s
Lay on Hands have no effect on pastrasites.
Spectral Thought-Worms
Spectral thought‐worms are tiny parasitic creatures
native to the Astral Plane. Their preferred habitat is
a conscious mind, where they subside on thoughts
and ideals. When a creature interacts with the Astral
Plane (via the astral projection spell or magic item
mishaps) without the protection of a mind blank
spell, or when it suffers prolonged exposure to the
less stable areas of the Astral Plane’s wild energies.
Spectral thought‐worms can also be carried along a
detect thoughts spell, a telepathic connections, and
similar effects. A creature exposed to a spectral
thought‐worm or an infected creature’s mind must
make a DC 15 Charisma saving throw or contract
the disease.
In 1d4 days the spectral thought‐worm’s
symptoms manifest in an infected creature. The
parasite infests the character’s mind and eats the
infected creature’s identity, creating a mental space
into which it will lay its eggs. An infected creature’s
background characteristics start changing. Roll 1d4
to determine what changes (personality trait, ideal,
bond, or flaw) then re‐roll the chosen characteristic.
This is the infected creature’s new belief structure,
which the character might not notice on its own.
An infected creature that does not have these
characteristics has its memories altered instead
(as the modify memory spell).
When an infected creature finishes a long rest, it
makes a DC 15 Charisma saving throw. On a success,
Planar Diseases  |  EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game
the character’s mind fights against the spectral
thought‐worm; in the resulting struggle, one of
its characteristics changes as above. On a failure,
the worm clears enough space to lay eggs that
hatch in 1d4 days. These start eating the infected
creature’s personality, reducing its Charisma score
by 1 each day until the infected creature’s Charisma
score reaches 0; the infected creature dies, and the
spectral thought‐worm escapes to the Astral Plane
through the tiny planar opening created by the
departing soul.
Spectral thought‐worms are susceptible to
psychic damage (thus their penchant to hide
within minds as a shield against astral energies).
When an infected creature is targeted by lesser
restoration or takes psychic damage equal to or
more than its Charisma score, the parasite goes
dormant for a week. A dormant spectral thought‐
worm is destroyed when the infected creature takes
psychic damage equal to or more than its Charisma
score. Upon destruction, a spectral thought‐worm
dissolves into stray thoughts that are expelled
throughout the next day as semi-insightful sayings
that float through the character’s mind. e
fungal
bums
A supplemental adventure for 4–5 PCs of 3rd–6th level

T hey say they’re only

hitching a ride, but can you

really tolerate a grove of talking

mushrooms sprouting from your

back? It started as a little itch after

defeating some mushroom beasts,

an ailment no healer seemed able

to cure. Then you started to feel

stronger, better than before—so

you’re rationalizing, thinking you

should tolerate or even trust the writing Andrew Engelbrite

color art Jeff Chen
little bums. After all, they are a maps Dyson Logos
editing Mike Myler
part of you now … layout Eric Life-Putnam

EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game  |  Fungal Bums
Background
Umamish are sentient parasites that siphon off
nutrients while slowly integrating their fungal
roots into a creature’s nervous system until the
infestation takes full control of the host, compelling
it to seek out dark damp places and lure or capture
others for infection. A local legendary swamp
monster nicknamed Uncle Switchback is suffering
from the late stages of umamish infection, and the
normally gentle giant has begun snatching local
fisherfolk to deposit into her muddy cavern home
to be further vessels for the insidious fungus.
Supplemental
Adventure
This adventure is best played throughout a
campaign, starting at 3rd level with the Local
Legend encounter, which results in a PC becoming
infected with umamish. The infection should
be allowed to progress over time (see Umamish
Infection) as the party pursues other quests. Once
the adventurers reach 6th level, the threat of the
umamish should be made clear, and “Fungal Bums”
can conclude with the Mushroom Samba encounter.
Alternatively, this adventure can be a self-
contained quest by using a hardened version of
the Local Legend encounter while the PCs are 6th
level, progressing rapidly through the infected
PC’s umamish infection and finishing with the
Mushroom Samba encounter the next day.
Local Legend
“Fungal Bums” begins in any town or settlement
near a lake, river, bog, swamp, or other natural
body of water that could hide a Large-sized creature.
Bartholomew Skinner (a halfling bandit captain)
has recently been attacked by Uncle Switchback
and is looking for brave adventurers to go after the
beast. Wherever he encounters the PCs, read or
paraphrase the following:
A scraggly old halfling man runs up to you in a panic,
“You lot! You lot look likes you can handle yourselves,
what with all them armor and swords and things ya
Fungal Bums  |  EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game
Alternative Creatures
If a dinosaur doesn’t fit in with the rest of the campaign,
after adding in the statistics of fourth-stage umamish
infection the following creatures can stand in for Uncle
Switchback: manticore, mummy, owlbear, wight,
winter wolf, yeti.
carrying. It’s old Uncle Switchback, he’s gone mad!
Every sailor ’round here knows the old Uncle, ’tis
a great big friendly thing … or it was. Something’s
got to him! Pulled both my mates right off the boat!
Didn’t kill ’em neither, drug ’em off to his lair. I knows
where it is! I can take ya!
Bartholomew owns a small fishing vessel named
Low Tide that can take the PCs to Uncle Switchback’s
lair about half a day’s sail from town. Bartholomew
has little to offer in payment except a promise to
take the party anywhere they’d like after this ordeal
has passed—assuming his shipmates make it out
alive. He drops anchor a few hundred feet from a
roughly spherical cave about 40 feet wide, half of
which is flooded with water 10 feet deep and the
rest with thick mud that counts as difficult terrain.
Bartholomew’s trio of crewmates (halfling bandits)
have been stuck up to their necks in the mud
and are all infected with umamish spores. Uncle
Switchback (a plesiosaurus suffering from fourth-
stage umamish infection) fights until killed.
Uncle Switchback is covered in muck, moss, and
mushrooms and filled with the blind commands of
rage sent directly to his brain by the umamish. If
by chance or ingenuity the PCs manage to avoid
infection, the adventurer with the lowest saving
throw result against his Umamish Explosion
becomes infected. One way or another, at least
one PC should end this encounter infected with
umamish; the symptoms take days to appear, and
saves may be rolled secretly at the GM’s discretion.
The old sailors are somewhat sad that their local
legend had to be put down, but thankful for the
party’s help. Bartholomew pledges his crew to
aid the PCs, and from this point forward the
adventurers can count on the Low Tide to transport
them across the local waterways.
Uncle Switchback
Large beast, unaligned
Armor Class 14 (natural armor)
Hit Points 76 (8d10+32)
Speed 20 ft., swim 40 ft.
STR DEX CON INT WIS CHA
20 (+5) 17 (+3) 18 (+4) 2 (–4) 12 (+1) 5 (–3)
Skills Perception +3, Stealth +5
Damage Immunities poison
Senses passive Perception 13
Languages —
Challenge 3 (700 XP)
Hold Breath. Uncle Switchback can hold his breath for
1 hour.
Umamish Explosion. When Uncle Switchback dies, his
corpse explodes with a burst of spores. Each creature
within 50 feet of him must make a DC 15 Constitution
saving throw, becoming infected with umamish on a
failed save.
ACTIONS
Bite. Melee Weapon Attack: +7 to hit, reach 10 ft., one
target. Hit: 14 (3d6+5) piercing damage plus 4 (1d6)
poison damage and the creature must make a DC 15
Constitution saving throw or become infected with
umamish.
Umamish Infection
Umamish are unique among fungi as they are
the only parasitic fungus known to have gained
sentience. These parasites extract their host’s
nutrients while invigorating the victim to keep it
alive long enough to spread further spores. When a
beast or humanoid creature is exposed to umamish
spores, it must make a DC 15 Constitution saving
throw or become infected.
It takes 1d4 days for the infection’s first symptoms
to manifest in an infected creature. The umamish
then grow slowly and their rate of growth varies
greatly depending on their host.
Whenever the infected creature advances in a
class level, their umamish infection progresses to
the next stage (if running this adventure as a short
self-contained quest, progress the infected PC
immediately to stage 4 infection when they wake
EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game  |  Fungal Bums
the following day.) For NPCs or creatures without
class levels, umamish infection progresses to the
next stage automatically every 1d4 weeks. If the
infected creature spends the majority of its time
in a damp and dark environment such as a cave,
swamp, or dungeon, its infection progresses to the
next stage every 1d2 weeks.
First Stage. First stage symptoms include warty
growths and a persistent rash that covers most
of the back and shoulders. The infected creature
regains only half the normal number of hit points
when spending Hit Dice during short rests as
the fungal infection siphons off its vitality. The
umamish also act as a blood filter for their host,
giving the infected creature immunity to poison
damage and all other nonmagical diseases.
Second Stage. At the second stage of infection
the umamish sprout as full mushroom caps with
eyes and mouths, gaining the ability to speak and
understand any language their host knows. The
umamish lie and plead with their host to keep
them “happy” about their presence, presenting
themselves as “symbiotic.” The umamish make
Charisma (Persuasion) and Charisma (Deception)
checks with a +8 bonus. As the mushrooms
intertwine with a substantial amount of muscle
tissue, the infected creature gains a +2 bonus to
both its Strength and Constitution ability scores.
Third Stage. At the third stage of the infection, the
umamish fully integrate into their host’s nervous
system. The infected creature gains a +2 bonus to
its primary spellcasting ability score (or Dexterity
if the infected creature does not have the Pact
Magic or Spellcasting features). The umamish also
become constantly aware of the infected creature’s
surface thoughts as per the spell detect thoughts.
Fourth Stage. At the fourth and final stage of
infection, the umamish attempt to control the
mind of the infected creature and spread their
spores. The infected creature becomes charmed
by the umamish as per the spell geas, and it is
compelled to infect other creatures with umamish
spores and to take infected creatures to damp dark
places. Whenever the infected creature hits another
creature with a melee attack, that attack deals an
additional 3 (1d6) poison damage and the creature
must make a DC 15 Constitution saving throw or
become infected with umamish. In addition, when
the infected creature dies, its corpse explodes with
a burst of spores. Each creature within 25 feet of
it must make a DC 15 Constitution saving throw,
becoming infected with umamish on a failed save.
For every size category larger than Medium the
infected creature is, the radius of this trait doubles.
Roleplaying Umamish
Umamish are mischievous, mean-spirited, and
manipulative. Having an umamish infection is
like having a crowd of hecklers on one’s back. An
umamish infestation usually consists of about a
dozen individual mushroom caps that all chatter
away at each other and poke fun at their host when
it fails at something. However, they’re excellent
at pleading for their continued “partnership” and
endlessly proclaim the many “benefits” from
allowing them to hang around.
Curing Umamish Infection
An umamish infection is extremely difficult to cure
and normal medical and magical means such as
the lesser restoration and greater restoration spells
are ineffective, as is a paladin’s Lay on Hands.
Umamish are still acting as a blood filter for
their host, however, and they can be overloaded by
particularly strong toxins. The infected creature is
immune to poison damage, but when this immunity
would prevent the infected creature from taking 20
or more poison damage from a single attack, the
umamish infestation withers away and the creature
fully recovers from the disease.
Mushroom Samba
As they progress through 4th and 5th level, infected
PCs deal with the infection throughout numerous
encounters as their condition continues to become
more severe. Once the adventurers reach 6th level,
the infections are at the fourth stage and the
umamishes’ true intentions become clear as they
attempt to assert control.
Fungal Bums  |  EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game
The PCs are offered a lifeline as Bartholemew
Skinner tracks down the party to give them the
good news—his crew came down with the same
umamish infection that afflicts the adventurers and
he found a solution. A druid named Pendlewine
(who specializes in fungi living deep in the
marshlands) was able to cure his crew, and he
offers to take them to immediately see the healer.
Pendlewine (NG gnome druid 15) lives within
a secluded grotto above a wide marshland. His
cavernous home has a natural stream running
through it and is coated in countless species of
exotic fungi. Once the PCs reach his home, read or
paraphrase the following:
The umamish chuckle and mock the recumbent gnome
with jeers of “This is it? You think this pudgy thing will
get rid of us? HAH!”
  The gnome takes a puff of his pipe and says, “I see
the problem, persistent little buggers ain’t they? Well
young pilgrims you’ve found just the humble healer
who can silence them for good. Though I’ll warn you,
the medicine for this particular little ailment is tough
to swallow. So before I proceed, are you absolutely
sure you want the cure?”
Pendlewine is vague about the nature of his “cure,”
and the umamish are quick to denounce him as a
charlatan. Assuming that the PCs decide to accept
the strange gnome’s cure, the druid instructs
them to “get ready” and begins preparing a spell.
Pendlewine casts transport via plants and passes
through a large mushroom, leaving the adventurers
to wonder for a moment before an even more
confused young green dragon is unceremoniously
flung back through the same portal!
The dragon is confused and angry, and it fights
until killed, starting with its poison breath attack
that is conveniently a perfect cure for the umamish
infection. The poison overloads the fungus, which
then withers away and dies. Pendlewine returns
once the dragon is killed, smugly asking, “How
do the patients feel? I normally whisk the dragon
away after it breathes out that lovely cure but you
all seemed to be having such fun.”
Resolving the Adventure
In addition to ridding themselves of the umamish
plague, the PCs should find themselves in
possession of a dragon carcass. The horns, scales,
and teeth are worth a total of 1,850 gp once properly
harvested. Pendlewine can also be counted on to
help with any odd ailments in the future, though
his “cures” are usually as bad as the disease. Finally,
Bartholemew and his crew still feel indebted to the
party and can ferry the adventurers where they
need to go for any future adventures. e

EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game  |  Fungal Bums
pallid
piper
A supplemental adventure for 4–5 PCs of 7th–9th level

U mamish are chatty and

manipulative fungal para­
sites that slowly take control of
a host’s mind to spread to fresh
victims. You’ve eradicated this
infection before, but someone has
taken it upon themselves to help
the mushrooms along—at every
turn you run into fresh infestations,
and news is spreading of a Pallid
Piper inflicting the umamish on
the unwitting then disappearing
with a song.

writing Andrew Engelbrite

color art Indi Martin
maps Dyson Logos
editing Mike Myler
layout Eric Life-Putnam

Pallid Piper  |  EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game
Background
The Pallid Piper is the creation of a demon lord:
the Fungus Queen. While it resembles a human,
its flesh is a purely a fungal construct. As of late
many of the fungoid races have parted ways with
the fiendish monarch; she intends to use the Piper
to bring them back in line, and she plans to make
many more if the first proves successful. The tune
of the Piper causes spores to quickly take root
and minor molds to overgrow into full-blown
infestations while the unnerving joyful melody of
the Fungus Queen fills the hearts of victims even
as their bodies moulder before their eyes. The
Pallid Piper is now loose, and if his song reaches
a crescendo the world will celebrate joyfully while
falling to his evil master.
Supplemental
Adventure
This adventure is best played throughout an existing
campaign as a series of side quests, starting with
the PCs’ first encounter with the Pallid Piper in the
Sporecap A Cappella encounter at 7th level. This
encounter is followed up while the PCs are at 8th
level with the Mycelium Harmonies encounter
and concludes at 9th level with the Fungal Finale
encounter. This is a sequel to “Fungal Bums” and
shares several themes, mechanics, and characters
(including umamish infection; see “Fungal Bums”).
Each can be used separately or fused together for
one extended adventure to weave into an existing
campaign.
Alternatively, this adventure can be used as a
self-contained quest by running the Sporecap A
Cappella and Mycelium Harmonies encounters
while the party are 9th level, progressing rapidly
through the encounters back-to-back rather than
spacing them throughout other adventures.
Sporecap A Cappella
The adventure starts in any small village or
settlement that the PCs are traveling towards—the
Pallid Piper has visited it and chaos has erupted in
EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game  |  Pallid Piper
his musical wake. Ideally, this should be a village the
party have visited before and had an opportunity to
experience before the Piper’s visit. It’s also ideal if
the adventurers are returning to this town after the
completion of some quest.
This place is not as you remember it. A seemingly
infinite variety of fungi sprouts from every bit of wood
in sight, and slime molds coat the cobblestones,
envelop the carts, and cover wares seemingly
dropped and scattered everywhere in haste. Patches
of brightly colored mushrooms sprout out from
odd angles, giving the town a hauntingly festive
appearance. You hear singing up ahead from a chorus
of voices each reciting a joyful tune, though the
words themselves are jarring and unnerving—a trio
of figures stalk the town square, each with a choir of
umamish on their backs, and a fungal mass sits at the
center eagerly devouring bodies.
The adventurers and their umamish are singing in
Abyssal; if any of the PCs can understand it, they’ll
hear various refrains about “hark the Piper” and
“decorating for the Fungus Queen”. If the party
makes a DC 15 Intelligence (Religion) check they’ll
recognize the Fungus Queen as a demon lord,
though the Piper should still remain mysterious.
The shambling mound that has arisen here is
happily devouring corpses and fights until slain.
The diseased NPCs are Kurt Roseheart (a NG human
knight), Elanda Leftfoot (a CG halfling priest), and
Yotul the Wise (a LG half-orc mage), all suffering
from the effects of fourth-stage umamish infection
(see “Fungal Bums”) and ultimately under the Pallid
Piper’s control. These afflicted fight until killed
unless they are cured of their umamish infection
through excessive poison damage, at which point
they immediately join alongside the PCs (though
they refuse to kill their companions and prioritize
curing them).
The Piper’s song has also sprouted up numerous
clutches of extremely toxic mushrooms. Randomly
place five such mushroom clutches around the
combat area, with each patch occupying a 5-foot
square. Any creature that enters one of these
squares must make a DC 18 Constitution saving
throw or immediately take 25 poison damage.
As the encounter begins, any PC with a passive
Intelligence (Nature) of 12 or higher recognizes the
toxic mushrooms.
Once the PCs defeat the monstrous plant and
defeat or cure the diseased NPCs, the fungal
presence seems to fade, and many of the large
fungi start rotting away as the song ends. The
townsfolk slowly emerge from their buildings
shortly after the singing stops, celebrating the
party’s victory and treating them as conquering
heroes. The adventurers are rewarded with free
amenities such as lodging and food, along with
their choice of local wares.
When questioned about the mushrooms, the
townsfolk speak of a strange old man that strode
through town playing a jaunty tune on a strange
flute—and the monstrous fungal mound that
sprouted up around him as he played. They recount
how the trio of outsiders charged the old man, and
how their backs suddenly sprouted fungus as he
simply disappeared.
If any of the diseased NPCs are cured and survive,
they pledge a life debt to the party. At the GMs
discretion, they can be asked to come along on a
future quest and will obey the PCs orders to the best
of their abilities (though they won’t harm innocents,
each other, or do anything obviously suicidal).
Mycelium Harmonies
This encounter begins while the PCs are 8th level
and traveling through the wilderness.
A jaunty tune pipes up ahead, though what you spot
around the bend is far from jovial. An old man plays
his flute a few paces across from a stout gnome fellow
desperately crawling away while competing fungal
growths surge around them. He reaches out and
pleads in a pained voice, “help me!”
Adventurers who played through “Fungal Bums”
instantly recognize the gnome as Pendlewine
(NG gnome druid 15), the druid that previously
Pallid Piper  |  EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game
cured their umamish infections. The Pallid Piper
is attempting to control him, and Pendlewine is
having to focus all of his effort into resisting the
Fungus Queen’s insidious song.
The Pallid Piper has already used Flourishing
Rot to conjure violet fungus and relies on them
to distract the PCs while he works on controlling
Pendlewine. If attacked, the Piper turns his
attention to the party, combining fungal black
tentacles with pseudopod attacks. Pendlewine is
incapacitated throughout the combat.
Once the Piper is brought to 50 hit points or below,
he cuts his losses and uses transport via plants to
escape through a nearby mushroom. Should the
PCs be inclined to follow him, Pendlewine warns
them off and uses his own powers to block the exit
with thick fungi.
After the Piper departs, Pendlewine thanks the
party and explains the creature’s true nature—and
the imminent threat posed by the Fungus Queen.
He then takes his leave, begging the PCs to aid him
once he can find a way to track the fiend down.
Pallid Piper
Medium plant, chaotic evil
Armor Class 16 (natural armor)
Hit Points 119 (14d8+56)
Speed 30 ft.
STR DEX CON INT WIS CHA
14 (+2) 18 (+4) 18 (+4) 12 (+1) 15 (+2) 19 (+4)
Saving Throws Dex +8, Wis +6, Cha +8
Skills Perception +6, Performance +8
Damage Immunities poison
Damage Resistances cold, fire, lightning; bludgeoning,
piercing, and slashing from nonmagical weapons
Condition Immunities charmed, exhaustion, fright-
ened, poisoned
Senses darkvision 60 ft., passive Perception 16
Languages Abyssal
Challenge 11 (7,200 XP)
Fungus Queen’s Herald. Any fungal plant creature or
creature afflicted with umamish infection (see Fungal
Bums) that targets the Piper with an attack or a
harmful spell must first make a DC 16 Wisdom saving
throw. On a failed save, the creature must choose
 a new target or lose the attack or spell. This spell
doesn’t protect the Piper from area effects, such as
the explosion of a fireball.
Innate Spellcasting. The Piper’s spellcasting ability
is Charisma (spell save DC 16, +8 to hit with spell
attacks). He can innately cast the following spells,
requiring no material components:
At will: chill touch, detect magic, locate animals or
plants
3/day each: black tentacles (fungal in appearance),
dispel magic, entangle, plant growth (fungal plants
only)
1/day each: transport via plants (fungal plants only)
Piper’s Tune. While conscious, the Piper constantly
plays a magical prayer to the Fungus Queen causing
mushrooms and lichen to flourish around him. A fun-
gal plant creature or creature afflicted with umamish
infection that starts its turn within 30 feet of the
Piper (including the Piper) regains 5 (2d4) hit points.
In addition, any creature afflicted with umamish
infection that starts its turn within 30 feet of the Piper
must make a DC 14 Constitution saving throw or its
umamish infection progresses to the next stage.
ACTIONS
Multiattack. The Piper makes two pseudopod attacks.
Pseudopod. Melee Weapon Attack: +8 to hit, reach
10 ft., one target. Hit: 7 (2d6) bludgeoning damage
plus 13 (2d8+4) poison damage.
Flourishing Rot (1/Day). The Piper magically grows
either a shambling mound or 3d4 violet fungus in
unoccupied spaces that he can see within 50 feet.
Whatever is conjured acts on the Piper’s initiative
starting at the beginning of his next turn, obeying his
spoken commands.
Fungus Queen’s Orders. The Piper chooses a fungal
plant creature or creature afflicted with umamish
infection he can see within 30 feet. If the target can
hear the Piper, it must succeed on a DC 16 Wisdom
or be charmed by the Piper. The charmed target
regards the Piper as a trusted friend to be heeded
and protected. Although the target isn’t under the
Piper’s control, it protects the Piper to the best of its
abilities. A creature can repeat the saving throw at the
end of each of its turns, ending the effect on itself on
a success.
EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game  |  Pallid Piper
Fungal Finale
This encounter kicks off as the 9th-level PCs are
in a relatively calm area. Pendlewine returns and
announces that he’s located the Pallid Piper with the
help of some unlikely allies—a trio of commoners
he’s brought with him who are obviously suffering
from fourth-stage umamish infection, though
the fungus is uncharacteristically subdued and
unaggressive. The druid explains that the umamish
are wholly against the Fungus Queen’s takeover of
their kind and are happy to help cut off her influence
by revealing a secret about their nature: all of them
are grown from the same sporestalk, and they
can sense one another across the Material Plane.
Thanks to these umamish, Pendlewine knows
exactly where the Piper is hiding and can take the
PCs there whenever they’re ready. Unfortunately
he and the umamish can’t help once they arrive, as
their fungal nature makes them far too susceptible
to the Piper’s control.
1. Marshy Crag
Once the PCs are ready, Pendlewine uses transport
via plants to take them directly outside the Piper’s
hidden grotto into a small cave beneath a hot and
humid rainforest canopy. To the north, a narrow
crack in the stone leads further in and is framed by
colorful mushrooms (area 2).
2. Fungal Gallery
A central column is absolutely covered in shelf
fungus, and bizarre fungal growths mark the walls.
A passage to the west curves into a spiraling slope
downwards (area 4), the ominous and oddly joyful
song of the Piper spills from a further chamber to
the north (area 5), and a wide passage choked with
humid fog opens to the east (area 3).
3. The Nursery
This chamber is hot with mulch and decay,
drenched, and smelling of death. A central mound
of soft peat was once half a dozen locals who came
to inspect the cave. Anyone who attempts digging
into the mound quickly discovers as much but can
recover numerous cultural artifacts and jewelry
worth 400 gp to museums or researchers, or 800 gp
if returned to the relatives of those lost here. A wide
passage choked with fog opens to the west (area 2).
4. The Piper’s Respite
This lower area houses the closest thing to a home
the Piper has: a bed of loamy soil he rests in to
recuperate. It also contains 4 explorers (veterans)
suffering from fourth-stage umamish infection
being used as servants, a remnant of a failed
expedition to this jungle. The location of each is
marked on the map in this area with a star. They
fight until killed or cured of umamish infection, at
which point they aid the PCs to the best of their
abilities in any attempt to kill the Piper. A tunnel
curves upward towards the southern end of this
chamber (area 2).
5. The Doorman
This broad chamber holds a beast once worshiped
as a jungle god, now diminished to being the Piper’s
guard dog. A giant ape suffering from fourth-stage
umamish infection sits in the spot marked with a
star, his umamish caps endlessly singing Abyssal
praises to the Fungus Queen. It attacks any non-
fungal intruder and fights until killed. A narrow
passage draped with colorful mushrooms leads
south (area 2), and a downward slope heads into a
tunnel to the northwest (area 6).
6. The Audience Chamber
This cavern is decorated in bizarre and exotic fungi
arranged and flourishing like the most elegant
of gardens. Sizable patches on the western and
eastern walls are coated in a particularly noxious
shelf fungus. A creature that enters a square with
one of these toxic patches (marked with the jagged
Pallid Piper  |  EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game
lines) must make a DC 18 Constitution saving
throw or immediately take 25 poison damage. The
southern wall is slicked with a slime mold that the
Fungus Queen transmits her visage into to check
upon the Piper’s progress. An upward slope leads
through a tunnel to the northwest (area 5).
As the PCs arrive, the Piper is reciting a new song
of his master’s praise and their interruption puts a
scowl on the Fungus Queen’s face. In Abyssal, she
says, “prove your worth or wither” then disappears
from the slime mold. The furious Pallid Piper fights
until killed. If the explorers from area 4 aren’t
already killed or cured, they arrive to defend him
in 1d4 rounds and spread umamish infection as
quickly as possible.
Resolving the
Adventure
While not treasure in the traditional sense, the
fungus in these caves was genuinely and carefully
nurtured and is worth over 8,000 gp to the right
botanists or poison makers. Pendlewine offers to
safely harvest them for the PCs if he sees them
hack away at the fungus like amateurs, and he’s
also willing to transport the party wherever they’d
like to be dropped off once they’ve finished looting
the caves.
In addition, the remaining “allied” umamish
commoners have a somewhat disquieting offer to
make: to infect any of the PCs on a more “symbiotic”
level that attains sentience but never progresses
past first-stage infection or attempts to take control.
Any adventurer who accepts gains immunity to
poison damage and non-magical diseases, as well
as some chatty stowaways—and whether or not
their offer is genuine or a trick is up to the GM. e
 N
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EN World EN5IDER: Sickness and Health: Diseases for Your 5E Game  |  Pallid Piper
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ENWorld EN5IDER: Sickness and Health: Diseases for Your 5E
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