Procalcitonin as a Potential Prognostic Marker in Advanced Hodgkin Lymphoma: A Case-Based Perspective

This case report examines the potential role of procalcitonin (PCT) as a prognostic biomarker in classic Hodgkin lymphoma (cHL), focusing on a 61-year-old male with advanced disease and systemic inflammation. The patient presented with progressive dyspnea, bilateral pleural effusions, and mediastinal lymphadenopathy. Imaging revealed hepatic, splenic, and adrenal involvement, consistent with stage IV HL. Axillary lymph node biopsy confirmed lymphocyte-rich cHL, with immunohistochemical markers including CD30, CD15, PAX5, Ki-67, MUM1, and BCL6. Despite broad-spectrum antimicrobial therapy and a comprehensive infectious workup, the patient exhibited rising PCT levels (peak 4.5 ng/mL) and declining albumin levels, with no microbiological evidence of infection. This persistent elevation of PCT in the absence of confirmed infection suggests a possible link between HL-associated inflammation and PCT production, potentially mediated by cytokine-driven paraneoplastic processes. The patient's clinical deterioration and eventual death underscore the aggressive nature of extranodal HL and raise questions about the utility of PCT as a surrogate marker of disease activity. While PCT is traditionally used to identify bacterial infections, its elevation in this case may reflect tumor-induced systemic inflammation. This observation supports further investigation into the prognostic relevance of PCT in HL, particularly in older patients with extensive disease burden. Clinicians should interpret elevated PCT levels cautiously in oncologic settings and consider malignancy-related inflammation as a contributing factor. Future studies are needed to evaluate PCT dynamics across HL subtypes and treatment phases, potentially integrating it into multimodal prognostic models. This report suggests that PCT may offer valuable insights into disease progression and inflammatory status in HL.