Level 4 DiseaseRot Grub Infestation

Wriggling worms burrow through flesh, gobbling up important tissue and life energy as they feast.

Stage 0: The target recovers from the disease.
Stage 1: While affected by stage 1, the target loses a healing surge and gains vulnerable 5 necrotic.
Stage 2: While affected by stage 2, the target loses two healing surges. The target also takes a -4 penalty to skill checks.
Stage 3: The target dies and, if Small or Medium in size, immediately becomes a rot grub zombie under the DM’s control.
Check: At the end of each extended rest, the target makes an Endurance check if it is at stage 1 or 2.
11 or lower: The stage of the disease increases by one.
12-17: No Change
18 or higher: The stage of the disease decreases by one.

Published in Monster Manual 3, page(s) 167, The Book of Vile Darkness, page(s) 2-39.