Review: Pale Cachexia

Esther’s search for a cure for her mysterious illness known as the Pale Cachexia takes her deep into a dark forest, where she meets a girl named Seina living by herself in an isolated manor that might contain the answers she needs.

VN Game Den received a review copy of Pale Cachexia.

The gothic fantasy visual novel Pale Cachexia begins with a young woman named Esther venturing alone into a dark forest. She suffers from an illness known as the Pale, or the Pale Cachexia, which will slowly drain away all of her energy. There are legends of an apothecary living deep within the forest who found a cure for the Pale, and he’s Esther’s last hope of finding a cure. However, when she finally reaches the isolated manor deep within the forest, the only inhabitant is a girl named Seina, who now lives there alone and offers to let Esther look through her father’s research notes.

Esther moves into the mansion and begins searching through the notes left behind by Seina’s father Isaiah to trace his efforts to find a cure for the Pale, while also getting to know Seina as the two adjust to living together. The growing friendship between Esther and Seina adds many heartwarming moments to a story that is often unsettling and somber. Most of the story is focused on Esther and her search through Isaiah’s research, as well as her feelings as she struggles with the Pale and keeping her symptoms in check. Occasional scenes, however, put the player in Isaiah’s shoes as he researches the Pale himself. These dual perspectives gradually reveal more about the Pale, raising questions and mysteries that occasionally lean into horror.

This sense of horror is aided by the atmosphere built up through the music and art of this visual novel. The backgrounds are beautiful, with just the right melancholy edge to fit the haunting gothic tone of the story, and the sprites fit in with them perfectly. Much of the visual novel is told in the common ADV format, with the character sprites on the screen and lines displayed in dialogue boxes on the bottom. However, certain parts switch to something closer to NVL format and feature the narration and dialogue positioned at the center of the screen, either by itself or with the characters’ portraits on either side.

It is purely a kinetic novel, with no choices to be made and a single ending. The story unfolds slowly, and it’s a story about the characters’ relationships as much as it is about a quest to understand a strange illness. Themes of loneliness, friendship, and paranoia all run through Pale Cachexia, and in some way they are more important than the story about the Pale itself. The main characters are likeable, and I found myself understanding the characters and their motivations even with so many things still rooted in mystery. This is part of the reason for the story’s slow pace, to put that spotlight on the characters to bring them to life.

While the friendship between Esther and Seina might be at the heart of the story, the Pale and Isaiah’s research are still very important. Answers are gradually revealed over the course of the story, although they often bring with them new questions. Esther’s conviction that the Pale is purely a biological matter comes into question when she realizes Isaiah had eventually researched a supernatural origin, and the dark atmosphere makes the player also ask themselves if there are truly dark forces at work or if it is something else.

Overall, I would have liked a few more answers at the end, but leaving some parts open and mysterious might be intentional for this sort of story. Pale Cachexia should take a few hours to read through, and it’s well worth it for the characters and the unfolding mystery of the Pale, especially if you’re a fan of gothic fantasy.

You can buy Pale Cachexia from Steam or

Samantha Lienhard