I was bored, so I made a small list to illustrate just how detailed this game really is.
- Using the glowing hour glass while in the first room of basement 1 will transport you to home.
- If you somehow manage to spawn monsters in Home in such a way that the doors close, for example with a TM trainer, you can see that Isaac's door has a crack.
- If you blow up the carpet in Isaac's room, there's no trapdoor, which shows that he's just imagining everything.
- If you kill Big Horn during the attack in which he is holding Little Horn, Little Horn will spawn.
- In Greed Mode, there's a small chance that the Monstro will spawn before the Greed fight, which is hinted at in the trailer.
- When you defeat Rainmaker, it stops raining on the floor.
- The Notched Axe receives full charges when you pick up the Iron Bar, which is a play on how to repair tools in Minecraft.
- Faded Polaroid can open the strange door in Deep 2.
- Charm of the Vampire makes your reflection disappear in floors with water.
- tainted Lazarus reflection is always his other side.
- Lodestone ruins Dogmas Sprite.
- If you delete Blood Puppy's evil form with the eraser, it can no longer appear.
- If you have half a red heart and swap to keeper with Clicker, he will have half a coin heart.
- With Mama Mega and a golden bomb, you can use Mama Mega twice.
- The large bombs that only spawn in Ashpit can be turned into usable bombs using Safety Scissors.
- Mom's Bracelet allows you to pick up host heads and make them vulnerable.
- When small champion enemies die, they have a chance to drop a size-down pill. The reverse is also true for large champion enemies.
- If you enter a room with half a heart, Isaac pees on the floor, but with Eve it's blood, which is an allusion to the fact that God gave her her period because she ate the apple.
- Jacob's Ladder and other electrical attacks have more range in downpour and dross.
- When you defeat Dogma for the first time, but not The Beast, the image on the save file becomes a giant cross.
- If you use Esau Jr. more than five times in the same run, the glass breaks and spawns a red Abel.
- If you have both Berzerk and Suplex using School Bag, and Berzerk goes out during Suplex, a Mama Mega explosion will occur when you hit the ground.
- If you use Meat Cleaver in the Horny Boys boss fight, Hornfel (in his outside-the-minecart phase) and Loki will spawn.
- If you blow up the mirror in Downpour or Dross 2, you get minus seven luck.
- You can get rid of Tick with Match Stick.
- The Dogma item has an animated sprite, but you never get to see it.
- If you use the shovel in the tomb room in the Drak Room after unlocking the Forgotten, a chest will spawn.
- Great Gideon can be instantly killed with Chaos Card, which creates a crawl space beneath him.
Feel free to comment the facts I forgot, these are just a few that immediately came to mind.