ABSTRACT
We report the case of a 19-year-old woman with left orbital floor fracture after a motorcycle accident. She presented with headache and diplopia; computed tomography showed herniation of the inferior rectus muscle into the maxillary sinus with orbital floor fracture. She was admitted for observation of her concussion and tested positive for coronavirus disease 2019 (COVID-19) half a day after admission. Her COVID-19 symptoms were mild; the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antigen quantification test was below the standard value on the 10th day of hospitalization, and her isolation was lifted. She had diplopia with vertical eye motion disorder and underwent reconstruction of her orbital floor fracture on the 11th day. Although the orbital floor was connected to the maxillary sinus due to the orbital floor fracture, the presence and the viral load of SARS-CoV-2 in the maxillary sinus were unknown. The surgeons performed the operation while wearing N95 masks. A SARS-CoV-2 antigen quantification test and PCR test were performed on a sample from the maxillary sinus mucosa obtained through the orbital floor fracture before reconstruction of orbital floor with a titanium mesh implant; both were negative. To our knowledge, this is the first report of SARS-CoV-2 testing from the maxillary sinus immediately after COVID-19 recovery. We believe that the risk of SARS-CoV-2 infection from the maxillary sinus is small if the antigen test from the nasopharynx is negative.
ABSTRACT
BACKGROUND: The longitudinal observation of the detection of antibody responses to SARS-CoV-2 using antibody kits during the clinical course of COVID-19 is not yet fully investigated. OBJECTIVES: To understand the significance of the detection of anti-SARS-CoV-2 antibodies, particularly IgG, using a rapid antibody kit, during the clinical course of COVID-19 patients with different severities. METHODS: Sixty-three serum samples from 18 patients (5 asymptomatic and 13 symptomatic patients) were retrospectively examined using a commercial SARS-CoV-2 IgM/IgG antibody kit. PCR positivity of patient samples was also examined as a marker of current SARS-CoV-2 infection. RESULTS: IgG antibodies were detected in all cases in this study. The IgG detection rates reached 100.0% in samples collected on day 13 or later. IgG seropositivity after an initial negative status was observed in 13 patients (3/5 asymptomatic and 10/13 symptomatic cases). Interestingly, the persistence of both PCR and IgG positivity was detected in seven cases, of which three were asymptomatic. The longest overlap duration of the PCR and IgG positivity was 17 days in asymptomatic status. CONCLUSIONS: SARS-CoV-2-specific IgG production can be detected in all infected individuals, using a rapid antibody kit, irrespective of clinical status. However, these findings suggest that, in some infected individuals, particularly those with asymptomatic status, the presence of virus-specific IgG antibodies does not imply prompt viral clearance.