Left 4 Dead 2 - Bleed Out + Fog + Solo + Expert (Hard Rain)

BLEED OUT MUTATION - You don&have access to any First aid kits at any time. You start with pain pills and temporary health which cannot be permanently healed. The stages will only have pills, Adrenaline and occasional defibrillators. Random panic events appear to be one step away from being permanently on, and the Special Infected spawn rate seems to be doubled.