Mass-Like Oropharyngeal Crohn's Disease Responsive to Upadacitinib

Crohn's disease (CD) can involve the oropharynx, though mass-like presentations are exceedingly rare and diagnostically challenging. We report a 74-year-old man with colonic and perianal CD on infliximab who developed progressive oropharyngeal symptoms. Imaging and endoscopy revealed a mass-like oropharyngeal lesion, with biopsies showing non-necrotizing granulomas and no malignancy. Symptoms persisted despite corticosteroids and therapeutic anti-TNFα levels. After exclusion of alternative etiologies, oropharyngeal CD was diagnosed. The patient improved markedly after switching to upadacitinib, with resolution of symptoms and endoscopic findings. This case highlights an atypical CD manifestation and the role of Janus kinase inhibition in refractory disease.