After awakening from his coma in Loser Reborn, Marty finds that the hospital is being swarmed by Gla'aki's cult, who want to start a zombie apocalypse. Worse yet, his newfound companion Sarah "Sally" Sweet is kidnapped by the cultists to become Gla'aki's vessel. In order to save her, Marty must team up with the other protagonists of the Physical Exorcism Series to fight back against the undead and cultists.
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This game contains examples of:
- Back Stab: Miasma zombies and vampires are powerful when attacked from the front or side, but weaker when attacked from behind. Unfortunately, back attacks cannot be used against the ones summoned during the Final Boss fight.
- The Bet: Jade pays Brucie to heal Marty because she wants to place bets on his chances of success in defeating the cult and saving Sally. Notably, she bets against Marty, showing that she had him healed with the expectation that he'd fail, though she does make the wager fair by leaving hints about bosses. This also makes Brucie's subtle encouragement towards Marty come off as pragmatic, since he's betting money on Marty's success.
- Big Bad: Gla'aki is leading a zombie apocalypse cult to ravage a hospital and later the rest of the world. She also plans to use Sally's body to gain a physical form.
- Cutting Off the Branches: This game continues from the second ending of Loser Reborn, where Marty wakes up from his coma, only to find himself in a zombie apocalypse.
- Degraded Boss: During the Final Boss fight, there are normal enemy versions of the Miasma Giant boss. While their fight is resolved in a single roll instead of a drawn out boss battle, they do so much damage that the player might as well have just fought the boss version.
- Difficulty Levels: Normal mode uses standard 6-sided die, but hard mode only allows a maximum value of 3 for each die, making it harder to get good outcomes on checks.
- King Mook: The Miasma Giant and Deadly Curser are bigger and stronger versions of the Miasma Zombie and Cursers respectively. These two serve as the bosses of the first and second stratum respectively, though a standard encounter version of the giant can be summoned by Gla'aki in the Final Boss fight.
- Lighter and Softer: Despite the zombie apocalypse at the start of the game and ominous stinger at the end, this game ends relatively happier than its predecessors in the series, with both leads surviving and befriending each other. The two leads are also more sympathetic than the previous ones, with Sally being a genuinely kind and generous person and Marty retaining his positive Character Development from the previous game.
- Luck Manipulation Mechanic: The game has various events where the player must roll die to get a value, which is then used to determine the outcome of the event. Equipping better gear will add additional die to these events, making it easier to reach higher value thresholds. Lucy's items can also be used to spend LP to increase the die values, effectively increasing the range of good values.
- Maybe Magic, Maybe Mundane: Sally's items give Marty the luck he needs to succeed on his dice rolls. It's not confirmed if this luck is supernatural like the abilities displayed by Brucie, Jade, and Lucy.
- No Hero Discount: Justified. Brucie sells items to Marty at rather high prices because he cares more about making ends meet than heroism. He repeatedly states that he's an exorcist-for-hire rather than a hero of justice.
- Retcon: Although this game is supposed to continue from Ending 2 of Loser Reborn, it changes certain details. In the previous game, Marty obtains a gun from a dead cop in the hospital lobby, has no allies with him, and has to face Gla'aki and her zombies. In this game, Marty obtains a gun in one of the upper floors, enters the lobby with Sally, and has to fight living cultists in addition to Gla'aki and her zombies.
- Save Scumming: The player can save anywhere except during a boss battle, which is a necessary feature because of the dice-based gameplay. This is especially true for hard mode, where each die only goes up to 3, making it harder to meet the requirements for better event outcomes.
- Sequel Hook: After the credits, there's an ominous statement that Marty and Sally will be involved in Case 03: True Cannibal Boy, with an image of Hans popping up.
- Shout-Out: Bruce, when asked if he is fighting evil spirits for someone else:Uh, yeah... You think I became a superhero or something because of some dark past? "Bruce Lyne, the tragic boy who witnessed an evil spirit killing his parents in a dark alley when he was a kid." Hmph. Exorcists aren't selfless like those comic book heroes who want to fight crime and change the world. We're shallow by nature, just working to keep ourselves fed.
- Single-Stroke Battle: Mechanically speaking, all fights with individual normal enemies are resolved in one or two rolls. The dice rolls determine how much damage and money the player gets from the short encounter.
- Support Party Member: The cultists are a villainous example, since they cannot deal direct damage to the player when engaged. For every two enemies the player defeats, the cultists will curse the player so that they get fewer dice to work with. If two or more cultists are on the map, every dice roll will be nerfed.
- Winds of Destiny, Change!: Sally's compact and clovers have the ability to increase the value of dice rolls and Marty believes he's succeeding due to her luck rubbing off on him.
- The Worf Effect: For most of the game, Brucie is shown having an easier time against enemies than Marty, due to his prior combat experience as an exorcist. However, he's knocked out by Gla'aki to show how much of a threat she is once she has a physical body.
- Yank the Dog's Chain: The Stinger states that despite Marty and Sally successfully surviving the zombie outbreak, they will have to deal with a new "Cannibal Boy" incident in Case 03.