Warner Bros. Games and Turtle Rock Studios have officially announced the next expansion for Back 4 Blood. River of Blood will release on December 6 and will be included with the Annual Pass, Deluxe Edition, Ultimate Edition, or as a standalone purchase. This includes a brand new story campaign that features a five-map mission that has players travelling upriver. This includes supply stops and new enemies along the way as players will be introduced to new characters. Tala, a former cultist outcast now turned Cleaner will be accompanined by Jeff. Jeff is a friendly Tallboy that can be summoned for team assistance. Players will also have access to eight exclusive character skins and 12 exclusive weapon skins. There will be new weapons, accessories and cards, as well.

Turtle Rock has also announced Trial of the Worm, which is a free update for all players as it will release alongside the DLC. This cooperative PvE mode that allows players to determine the path through a four-map chain while earning Supply Points. Corruption Modifiers can be added along the way, or increased difficulty for higher Supply Points can be selected throughout the journey. Lastly, the Holiday Event will start on December 6 and last through January 4 as players can enjoy festive decorations, listen to holiday music, or equip holiday skins, emblems, weapons skins and sprays.