Ah, disease. One of the hallmarks of the medieval world, and, in a fantasy world, you can have all sorts of nasty plagues and poxes. This article contains an assortment of (I hope) imaginative and interesting infections with which to make your PCs regret ever saying “Ritual Caster? Feh! Why would we waste a feat on that? We want more dakka!”

Some of these diseases are listed with fixed levels, though it ought to be extremely trivial to raise or lower the level as needed. Some suggestions for making them nastier at higher levels are included.

Candlebone

This disease is named because it makes the bones soften and flow like candle wax. It is excruciatingly painful, but rarely lethal in itself, though it can lead to suicide as the victim contemplates a future of unending pain and virtual immobility.

Infection

Candlebone is usually the result of exposure to slimes, molds, or oozes. Any time a character is reduced to 0 hit points by the attack of such a creature, they may be infected. Make a secondary attack at creature’s level +3 vs. Fortitude; if it hits, infection has set in.

Candlebone Of The First Order

4th Level Disease

Stage 0: The target recovers from the disease.

Stage 1: While affected by stage 1, the target is at -1 to speed and, if he voluntarily moves more than his speed during his turn, will take 1d6+5 points of damage per square moved.

Stage 2: While affected by stage 2, the target is slowed, and is at a -2 to reflex defense, to Dexterity based skills, and to all attack rolls. If the target voluntarily moves more than his speed during his turn, he takes 1d6+5 damage per square moved.

Stage 3: While affected by stage 3, the target is immobilized and is at a -2 to Reflex defense, to Dexterity based skills, and to all attack rolls. The character may move up to two squares as a move action, but each square of movement inflicts 1d6+5 points of damage.

Check: At the end of each extended rest, the target makes an Endurance check if it is at stage 1 or 2.

Lower then 10: The disease worsens by 1 stage.

10-13: No change.

14+: The disease improves by 1 stage.

Variants

Candlebone of the Second Order: Level 14 Disease.

Changes: Damage for moving become 3d6+6. The character is at -2 Speed in stage 1. At stage 2, any time the character changes weapons or implements during combat, they must make a saving thrown or drop both the item they’re currently holding and the item they are trying to hold.

Lower then 15: The disease worsens by 1 stage.

15-20: No change.

21+: The disease improves by 1 stage.

Candlebone of the Third Order: Level 24 Disease.

Changes (based on Candlebone of the Second Order): Damage for moving become 4d8+8. In addition, at all stages, if the character takes more than their Surge Value from a melee attack or from falling damage, they will be stunned (save ends).

Lower then 21: The disease worsens by 1 stage.

22-27: No change.

28+: The disease improves by 1 stage.

Orc’s Curse

(8th Level Disease)

Infection

Orc’s Curse has little to do with orcs. It is actually transmitted by scale mites that infect many animals in the mountainous regions and rocky hills; these territories are often held by orcs, so it’s believed orcs either spread the disease or are all infected by it. Blood attracts the mites, and anyone who takes an extended rest while wounded (below full hit points) must make a DC 12 Endurance or Nature check, or become infected. The first stage of the disease occurs after the next extended rest, but a DC 24 Heal or Insight check (the DM should roll secretly unless the characters have some reason to deliberately check) will notice the signs of early onset, which will give a +2 bonus to the first Heal checks made to cure the disease.

When subject to the disease, the character is a bundle of fuming rage, lacking most self control and determined to lash out at any targets. Physical symptoms include heavy sweating, twitchiness, and a red-purple rash across most of the body.

Stage 0: The target recovers from the disease.

Stage 1: The target is easily outraged and takes offense at the slightest things. He is at a -2 to all Charisma based skills except for Intimidate. When bloodied, he has a +1 bonus to damage but a -2 to Armor Class and Reflex defenses.

Stage 2: In addition to the effects of Stage 1, if the creature is bloodied, they must make an attack every round; if they do not have a target in range at the start of their turn, they must move towards the nearest target and then attack. If the creature’s turn ends without it making an attack roll against a legitimate target, it will take 2d8+4 psychic damage.

Stage 3: The creature suffers a -2 modifier to all Charisma based skill checks, except for Intimidate, and, when bloodied, will always make a basic or at-will attack against the nearest target. If they go a full day without combat, after the next extended rest, they must make a saving throw every hour or attack the nearest creature.

Check: At the end of each extended rest, the target makes an Endurance check if it is at stage 1 or 2.

Lower then 12: The disease worsens by 1 stage.

12-16: No change.

17+: The disease improves by 1 stage.

Characters may substitute their Wisdom score for the Constitution score when making Endurance checks for this disease, if they wish. As a minor action, an ally within 5 squares with line of effect to the infected creature can make a DC 16 Diplomacy check to negate the effects of the disease until the end of their next turn. If this check fails by more than 4, the infected creature will attack the ally in preference to all other targets, if possible.

Variants

Ogre’s Curse: Level 18 Disease.

Changes: The DC to resist infection becomes 17, but it’s still only a DC 24 Heal check to notice signs of infection. Charisma skill penalties are at -4. Damage bonus when bloodied becomes +2, and Armor Class and Reflex penalties become -4. The psychic damage for not attacking becomes 4d8+8. In addition, any time the character takes damage equal or greater than his surge value, he is considered to be bloodied until the end of his next turn, regardless of his actual hit points. (His hit point total does not change, but he has the bloodied condition and all powers or effects which check for that condition work as usual.)

Lower then 17: The disease worsens by 1 stage.

17-22: No change.

23+: The disease improves by 1 stage.

Demon’s Curse: Level 28 Disease.

Changes (based on Ogre’s Curse): The DC to resist infection is 23, as is the Heal check to notice signs of infection early. Charisma skill penalties (other than Intimidate), become -6, and there is an additional -2 penalty to Wisdom based skills. When bloodied, the victim gains a +6 damage bonus and a -4 penalty to Armor Class, Reflex Defense, and Will Defense. The psychic damage for not attacking becomes 6d8+10. All other effects are as noted in Ogre’s Curse.

At the final stage of the disease, the creature suffers a -4 to Charisma based skill checks and a -2 to Wisdom based skill checks, in addition to the other effects.

Lower then 23: The disease worsens by 1 stage.

23-30: No change.

31+: The disease improves by 1 stage.

Aetheric Fluxion

Variable Level Disease

This disease is dreaded by wizards, sorcerers, and anyone else who uses the Arcane. It can only infect creatures who have an Arcane class, including multiclass or hybrid characters. (For NPCs and monsters without classes, the DM can judge if they can be subject to  this — obviously, it will only matter if they are allies of the PCs and will be traveling with them for a while.)

Infection

Aetheric Fluxion is a distortion of the flesh caused by mishandled magic. In areas of high ambient magic (DMs discretion; detecting such areas is an Easy Arcana check based on the area’s level), any time a character rolls a natural 1 when using an arcane power, or suffers a critical hit from an arcane power (and has an arcane class), they must roll a moderate Arcana check or become infected. Each such roll which occurs before an extended rest raises the DC by 2. The effects of the infection manifest the next time the character uses an arcane power, though if a week passes with no such use, the disease fades. A character may make a Hard arcana check at the level of the disease to know they are infected before the effects manifest, though this information has no direct mechanical effects. (It could inspire them to seek a cure before heading into a dangerous environment, though.)

The level of the disease is based on the level of the power that triggered the infection, so it may be lower or higher than the character’s own level.

Stage 0: The disease is cured.

Stage 1: At this stage, magic becomes hard to control. The creature suffers a number of minor magical effects, such as changes to skin color, odd flashes of light when he speaks, or small frogs leaping out of his ears. More seriously, he is at a -2 to all attack rolls with arcane powers, and takes damage equal to his attack attribute modifier + 1/2 his level when he misses with an arcane attack. If the attack power had a damage type, the damage is of this type.

Stage 2: In addition to the stage 1 effects, whenever the creature misses with an arcane power, a random ally within 10 squares takes damage just as the creature does.

Stage 3: The creature can safely cast at-will or basic attack arcane powers with no penalty or effects, but the use of an arcane encounter power triggers the effects of Stage 1, and an arcane daily power triggers the effects of Stage 2. In addition, strange magical phenomenon, as described for Stage 1, occur constantly around the character; if the character wishes to suppress these effects, they can make a Hard arcana check to suppress them for 5 minutes, or make a moderate arcana check and expend a healing surge to suppress them for a number of hours equal to the highest of their Intelligence, Wisdom, or Charisma modifiers. (Do not add 1/2 level, use the raw modifier). Failing to make either check causes a backlash that results in damage as per the Stage 1 effect.

Check: At the end of each extended rest, the target makes an Endurance check if it is at stage 1 or 2. A normal Heal check cannot be used to replace the Endurance check, but an Arcana check made by someone not subject to the disease can be. The victim of the disease cannot use their own Arcana for this, due to the nature of the disease.

Lower than Easy DC: The stage of the disease increases by 1

Easy DC: The disease remains the same.

Moderate DC: The stage of the disease decreases by 1