ATM and Cowden disease: For instance, a recent case report described the successful use of upadacitinib in a child with an ATM (ataxia-teleangiectasia mutated protein) gene mutation and refractory CD, who achieved rapid remission with upadacitinib after multiple biologic therapies had failed [15].The ATM gene mutation is involved in DNA repair mechanisms and known to influence immune function and inflammatory pathways, therefore this case highlights a potential therapeutic advantage of JAK inhibitors like upadacitinib in genetically complex cases.