We report a difficult case of a 45-year-old woman with refractory recurrent pericarditis, who was treated with several different medical therapies, pericardial window, and pericardiectomy. This case suggests that more invasive diagnostic and therapeutic choices, such as pericardial window and pericardiectomy, should be carefully considered for possible side-effects and the risk of promoting further recurrences. Non-steroidal anti-inflammatory drugs and colchicine are first-choice drugs, whereas corticosteroids should be considered only in patients with a frequent crisis unresponsive to non-steroidal anti-inflammatory drugs, and by using proper dosage and a careful slow tapering. Patience and appropriate medical therapy are the keys to successful management. In true refractory cases, combination therapy with two or three drugs such as non-steroidal anti-inflammatory drugs, colchicine and corticosteroid may be considered before applying other more complex and less safe treatments. Immunosuppressive drugs and steroid sparing agents might be used, but it should be acknowledged that only weak evidence-based data support their use.