Games like Puzzle Tower - Underground
Games like Puzzle Tower - Underground include Kindergarten, Death Coming/死神来了, Kindergarten 2, Party Hard, and CARRION. We matched them by the tags players give Puzzle Tower - Underground on Steam (Strategy, Adventure, Indie, Gore, and Violent): closest matches first, and among equally close ones the better-known games.

Kindergarten
Shared: Gore · Violent · Adventure

Death Coming/死神来了
Shared: Strategy · Adventure · Gore

Kindergarten 2
Shared: Adventure · Gore · Indie

Party Hard
Shared: Strategy · Indie · Violent

CARRION
Shared: Gore · Indie · Violent

[Chillas Art] Aka Manto
Shared: Indie · Gore · Violent

Hotline Miami
Shared: Indie · Violent · Gore

Blasphemous
Shared: Gore · Indie · Violent

Granny: Chapter Two
Shared: Adventure · Indie · Gore

Party Hard 2
Shared: Indie · Violent · Strategy

DOKA 2 KISHKI EDITION
Shared: Gore · Violent · Indie

Sands of Salzaar
Shared: Strategy · Indie · Adventure

Ultimate Epic Battle Simulator
Shared: Strategy · Violent · Gore

People Playground
Shared: Gore · Violent · Indie

Ludus
Shared: Strategy · Indie · Adventure

Raging Loop
Shared: Adventure · Indie · Gore

Home Behind 2
Shared: Strategy · Adventure · Indie

Run!ZombieFood!
Shared: Strategy · Adventure · Indie

Lucius
Shared: Adventure · Gore · Indie

Happy Room
Shared: Gore · Violent · Indie

Paint the Town Red
Shared: Gore · Violent · Indie

The Walking Dead: Saints & Sinners
Shared: Adventure · Gore · Violent

Serious Sam 4
Shared: Gore · Adventure · Violent

The Legend of Bum-Bo
Shared: Strategy · Indie · Adventure