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Ghoul Distemper

This rare, tropical disease causes living creatures to turn into feral, ghoul-like entities, and when fatal, often causes the affected creature to rise as a ghoul. The creature’s metabolism rises at an incredible rate, forcing it to devour untenable amounts of food. Eating only further fuels the disease, and all victims of this affliction quickly develop an emaciated, corpselike appearance.

Type disease, ingested, inhaled, or injury; Save Fortitude DC 18, see text; Frequency 1/day; Effect –2 penalty on Fortitude and Will saves for 1 day; Cure 2 consecutive saves



The affected creature becomes voraciously hungry, and must consume double the normal amount of food each day it remains at this stage or risk starvation.


The affected creature’s skin turns a deep shade of yellow, while the creature’s temperature begins to rise. Additionally, the affected creature’s ravenous appetite worsens. As long as it remains at this stage of the disease or worse, it treats each hour as though it were a full day for the purposes of the frequency and amount of food it must eat in order to avoid starvation (including time spent sleeping). Finally, it develops a strong craving for raw meat, and must consume at least 4 ounces of uncooked meat per hour or become sickened until it does so.


The affected creature’s body begins to quickly waste away, as muscle and fat are consumed to feed its growing hunger. Further, its body begins to constantly exude a stench of rotting meat, which cannot be removed with any amount of bathing. The affected creature is constantly sickened.

Additionally, whenever the creature takes nonlethal damage from starvation, it takes 3d6 points of damage, rather than 1d6. Finally, whenever it comes within 10 feet of any amount of meat, including the bodies of slain creatures, it must succeed at a Will save against the disease’s DC or be compelled to spend 1 minute gorging itself on the meat.


The affected creature’s teeth begin to grow and twist painfully, fusing together to form four massive fangs. The creature gains a primary bite natural attack that deals 1d6 points of damage (1d4 if Small). Further, its hunger-addled mind drives it to favor this attack over all others. It can no longer cast spells or use other activated special abilities, nor can it use manufactured weapons; it is able to make only full attacks with its bite and other natural attacks. Finally, whenever the affected creature takes nonlethal damage from starvation, it takes 6d6 points of damage, rather than 1d6.


The affected creature completely loses control. It is compelled to attack any living creature it encounters in an attempt to devour its victim’s flesh, preferably while still alive. Player characters who reach this stage are under the GM’s control until they are cured. Additionally, whenever the affected creature takes nonlethal damage from starvation, it also takes 2 points of Constitution damage. If it fails a saving throw against the disease’s progress at this stage, it dies. A creature that dies while at this stage of the disease rises as a ghoul (or ghast, if it had 5 or more Hit Dice) after 24 hours.