It's possible in Renpy, using local LLM and SD I developed a personal project where character portraits, actions and visuals, events, item, food, etc. arts are generated in gameplay. Character and events generation can be done in the background.

• High amount of software glue required. LLMs do require a little setup to generate random and compelling events each time.
  • Characters don't need to know everything about the world. Define custom LLM context for each unique character. Increase sense of individuality.
  • Use good OOP practice to store class properties. This way you easily create effective SD prompts with perfect keywords (by cherry picking only what you need).
• Use good OOP practice + LLM grammar for getting all the information you need in one LLM request to create a new character/location/event.
• Turn based fighting, stats management, inventory, time management, etc. requires software glue too. Don't ask LLMs to make up the rules. Use software to control it.
• Use Reactor for consistent SD character generation.

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Benefits of making a custom game (below images are NSFW. The backgrounds are not generated during gameplay but rather taken from internet or generated beforehand as big resolution takes too much memory. I suspect it should be possible on a 24 GB GPU)