Heatstroke is a life-threatening emergency characterized by elevated core body temperature and systemic inflammatory response, often resulting in multiorgan dysfunction. Exertional heatstroke (EHS), typically affecting young and active individuals, is frequently complicated by rhabdomyolysis (RM), a condition marked by skeletal muscle breakdown and the release of intracellular contents into the circulation. This process can provoke a sterile inflammatory response that closely mimics bacterial sepsis, posing significant diagnostic challenges. Serum procalcitonin (PCT), a widely recognized biomarker for bacterial infection and sepsis, has also been shown to rise in non-infectious conditions such as trauma, burns, and heat-related illness. In the context of EHS-associated RM, elevated PCT is more likely to reflect the severity of systemic inflammation and tissue injury rather than the presence of a true infection. Misinterpretation of PCT in this setting may lead to inappropriate antimicrobial use and suboptimal patient management. This review synthesizes current evidence on the relationship between RM and PCT in heat injury, emphasizing the pathophysiological mechanisms of PCT elevation, its limitations in infection discrimination, and its potential role as a prognostic biomarker. Clinicians are encouraged to interpret PCT levels in conjunction with clinical findings, temporal trends, and adjunctive markers to improve diagnostic precision and guide appropriate therapeutic strategies.