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Hex Pentimento's 5th stack effect can trigger without all five totems.
SUMMARY OF THE ISSUE: Now this appears to be a frame perfect bug, but there is some timing to it.
In my recent match today, I was facing a Doctor with a Hex build (Undying, Plaything, Devour Hope, and Pentimento). As I saw Pentimento was in play, I went to the spot I knew one would be at and cleansed it.
As I cleansed the Pentimento totem, the Doctor rekindled the fifth totem at the exact same time I finished cleansing. This resulted in Pentimento getting its fifth token despite losing one in the same second, so it's very likely the game took priority in the fifth stack being gained rather than the fourth stack being lost, so we had to finish the last two generators with the max penalty of Pentimento and the inability to cleanse them despite there being only four.
I did talk with the Doctor in the endgame chat about this bug and he was confused as I was.
PLATFORM: Steam
STEP BY STEP INSTRUCTIONS ON HOW THE ISSUE OCCURED: Basically, you need to rekindle the fifth Pentimento totem at the exact moment a survivor would finish cleansing one.
PHOTO: I forgot my keybind to capture the previous 30 seconds of gameplay, but I did get this screenshot of the Entity totem block effect on the spot where the totem I cleansed once was. As you can see, the totem is no longer there yet The Entity defends it.
PLAYER LOGS: