Hardcore Henry II

Needs a full main-story run in Hardcore mode, which strips the QoL you lean on: no player marker on the map, no fast travel, no autosave, plus the negative perks you're forced to pick. Stack it with Against All Odds by choosing every negative perk at the start of the same run - that clears both in one Hardcore playthrough. You only need the main story, not 100%, so beeline it. Save at inns whenever you can (Saviour Schnapps or a bed), navigate by landmarks and roads, and lean on the three least-punishing perks if you're only after this one and not the all-perks version.