After one month of upadacitinib therapy, the patient showed marked improvement in cutaneous lesions and bone pain, along with significant normalization of inflammatory markers and a pronounced reduction in IgE levels.<h4>Conclusion</h4>This case suggests that upadacitinib may be a valuable therapeutic option for patients with refractory SAPHO syndrome, particularly those presenting with paradoxical reactions or hypersensitivity. This evidence concerns the gene IGHE and SAPHO syndrome.