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Leech, Cave

Medium monstrosity, neutral

Armor Class 15 (natural armor)
Hit Points 112 (15d8 + 45)
Speed 30 ft., swim 30 ft.

15 (+2) 11 (+0) 17 (+3) 3 (-4) 12 (+1) 6 (-2)

Skills Perception +4, Stealth +3
Senses darkvision 60 ft., tremorsense 60 ft. passive Perception 14
Challenge 8 (3,900 XP)


  • Multiattack. The leech makes up to four tentacle attacks and can use blood drain on a grappled creature.
  • Tentacles. Melee Weapon Attack: +5 to hit, reach 5 ft., one target. Hit: 11 (2d8 + 2) bludgeoning damage. The target is grappled (escape DC 12) if the leech isn’t already grappling a creature, and the target is restrained until the grapple ends. While grappling a creature, the leech can’t use that tentacle. The leech has four tentacles.
  • Blood Drain. Melee Weapon Attack: +5 to hit, reach 5 ft. one creature. Hit: 9 (2d6+2) piercing damage, and the leech attaches to the target. While attached, the leech doesn’t attack. Instead, at the start of the leech’s turns, the target loses 9 (2d6 + 2) hit points due to blood loss. The leech can detach itself by spending 5 feet of its movement. It does so after it drains 25 hit points of blood from the target or the target dies. A creature, including the target, can use its action to make a DC 12 Strength check to rip the leech off and make it detach.


This large, bloated creature has a flattened, semi-translucent body of sickly yellow. Eight whip-like tentacles protrude from the monster’s front, near its head. Hundreds of smaller tentacles line its body and seem to aid in locomotion. Its mouth is rounded and ringed with dozens of needlelike teeth.

Though not aquatic creatures, cave leeches are often found lairing near underground rivers, lakes, and streams. They are aggressive creatures whose sole purpose seems to be to kill and devour any living creature that stumbles into their territory.

Cave leeches often lair with others of their kind. Food is not shared among them, so each leech is effectively on its own when hunting prey.

Quarrels over prey sometimes erupt between cave leeches lairing together; these disputes end when one of the leeches backs down or is driven away.

An adult cave leech measures about 8 feet long and its whip-like tentacles are each about 6 feet long. Cave leeches are often mistaken for ordinary giant leeches, especially when at rest because the creature folds its tentacles back against its body. They also do this when waiting to strike.

When a meal comes within range, the cave leech fires a tentacle out and attempts to grab its target. Grabbed prey is pulled in to the cave leech’s mouth and bitten by its horrible teeth. Living creatures trapped by its tentacles are held and bitten, the leech draining blood with its bite. A victim that is completely drained of blood becomes a dried, rotting husk and its body is cast aside. Foes killed by its bite attack are often dragged to the cave leech’s lair and fed to the young or drained of blood over several days. A cave leech sometimes uses the rotting husks of its victims to line its lair.

Section 15: Copyright Notice

Tome of Horrors © 2018, Frog God Games, LLC; Authors: Kevin Baase, Erica Balsley, John “Pexx” Barnhouse, Christopher Bishop, Casey Christofferson, Jim Collura, Andrea Costantini, Jayson ‘Rocky' Gardner, Zach Glazar, Meghan Greene, Scott Greene, Lance Hawvermale, Travis Hawvermale, Ian S. Johnston, Bill Kenower, Patrick Lawinger, Rhiannon Louve, Ian McGarty, Edwin Nagy, James Patterson, Nathan Paul, Patrick N. Pilgrim, Clark Peterson, Anthony Pryor, Greg Ragland, Robert Schwalb, G. Scott Swift, Greg A. Vaughan, and Bill Webb

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