Menagerie of Maladies

Homebrew Diseases for Dungeons and Dragons

By: Gryphon Games

P
a cure to a sick loved one, or preventing the
spread or creation of a new disease are all
classic plotlines in books and film. The
Dungeon Master’s Guide presents some
diseases and rules for the spread of the
disease to allow Dungeon Masters to bring
those stories to life at their game tables.
However, there are only three diseases presented in
the Dungeon Master’s Guide, and with abilities like a
paladin’s Lay on Hands or the lesser restoration spell,
diseases quicky cease to be a threat to a typical party of
player characters.
The following diseases offer unique and interesting
ways for a Dungeon Master to challenge players. Some
are difficult or dangerous to cure with magic, and others
are so deadly and contagious that even high-level magic
may not be enough to prevent their spread.
The diseases are organized into sections, based on
deadliness. They can be used against a part of any level,
but low-level parties may not be equipped to grapple
with deadly diseases. This may work in a Dungeon
Master’s favor, however, as such a disease can be used
as the basis for urgent quests to find a cure.
Mild Diseases
Coral Scratch
A fairly minor disease, Coral Scratch is a non-lethal
nuisance to anyone who gets cut by coral. A creature
that takes 1 or more slashing damage from coral must
succeed on a DC 11 Constitution saving throw or
contract the disease. The disease’s effects take place
immediately, and they include itching, redness, and
shivers. A creature afflicted by the disease has
disadvantage on Dexterity-based ability checks, attack
rolls and saving throws. An afflicted creature can repeat
the saving throw each time it completes a long rest,
ending the disease on a success.
A paste of salt water and crushed emerald kelp
applied to the wound cures the disease in one hour.

1
 Malaria 1d4 hours after contracting the disease, a creature’s
Mosquitos and other biting insects can carry malaria. Constitution score is reduced by 1d4. Each time the
Victims of the disease suffer from nausea, fever, diseased creature takes a long rest, it must repeat the
vomiting, chills and uncontrollable shivers. If allowed to saving throw. On a failed save, the creature’s
worsen, malaria can reach the brain, inducing Constitution score is reduced by an additional 1d4. On a
hallucinations and comas. Fatalities from malaria are successful save, the creature’s Constitution score is
usually caused by kidney failure. increased by 1. If the creature’s Constitution score is
At the end of each long rest in jungle terrain, a reduced to 0, it dies. If the creature’s Constitution score
humanoid not native to the jungle must make a DC 10 returns to normal, it recovers from the disease.
Constitution saving throw. On a failed save, the If a creature attempts to cure this disease through
humanoid contracts malaria, which lays dormant for magic, the creature doing the curing is immediately
1d6 days. Once the victim begins to show symptoms, it exposed to the disease. If a diseased creature imbibes
is poisoned until the disease can be cured. While an antitoxin, it regains 1d4 points of lost Constitution.
poisoned in this way, the creature must make a DC 10
Constitution saving throw at the end of each long rest, Deadly Diseases
gaining a long-term madness on a failed save. If the
humanoid is already suffering a long-term madness, it Death Knell
no longer has to repeat the save, and instead becomes One of the world’s deadliest diseases, Death Knell often
unconscious. After that, it dies 2d4 days later. If a kills those it infects in a matter of days. Death Knell has
diseased creature succeeds on the saving throw three only surfaced recently, and many theorize it is the
times, it recovers from the disease. sinister creation of cultists of a god of death and
pestilence.
Moderate Diseases Humanoids can contract Death Knell if they are ever
within 10 feet of a creature afflicted by the disease for
Ghoul fever more than 1 minute. When exposed to the disease in
A humanoid afflicted by ghoul fever cannot regain Hit this way, a humanoid must succeed on a DC 17
Dice and vomits up any food it consumes that isn’t raw Constitution saving throw or contract the disease. The
meat. At the end of each long rest, the afflicted creature symptoms of the disease appears 1d8 hours after it is
must succeed on a DC 11 Constitution saving throw or contracted, so asymptomatic humanoids can spread the
lose half its Hit Dice (rounded up). Once a creature disease completely unawares.
loses its last Hit Die, it dies and becomes a ghoul. If an Humanoids afflicted by Death Knell suffer from
afflicted creature succeeds on the Constitution saving forgetfulness, mind-fog, and fatigue. Once symtpoms
throws three times, it recovers from the disease. Magic manifest, a diseased humanoid’s proficiency bonus is
cannot remove the disease unless a remove curse spell reduced by 1. Whenever the diseased humanoids
is cast on the diseased creature first. completes a long rest it must repeat the saving throw.
A poultice of Mourning Bonny, a purple flower that On a failed save, the humanoid’s proficiency bonus is
grows in graveyards, can be prepared with a DC 13 reduced by 1 again. If a humanoid’s proficiency bonus
Wisdom (Medicine) check. A creature that consumes would be reduced to below 0 by this disease, it dies. On
the poultice gains advantage on its next save against a successful save, the creature’s proficiency bonus
ghoul fever. increases by 1. If the creature’s proficiency bonus
returns to normal, the creature recovers from the
Unpanacea disease.
Unpanacea is a disease accidentally created by
alchemists, in search of an elixir to cure all diseases.
Their experiments went horribly wrong, and the
alchemists’ dead bodies were discovered days later in a
state of complete exsanguination.
The alchemical disease slowly transmutes the blood
in a victim’s veins to water. Those afflicted by it look
increasingly pale and bloodless, and their limbs go
numb from lack of blood. A creature who makes contact
with the blood of a diseased creature must succeed on a
DC 14 Constitution saving throw or contract the
disease.