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Spontaneous nephrocutaneous fistula is a rare manifestation of renal diseases. The majority of such fistulas are associated with xanthogranulomatous pyelonephritis, chronic renal tuberculosis, complicated renal stones, and post-traumatic or surgical injuries. We report the case of a 58-year-old male who presented with a history of massive lumbar cutaneous purulent discharge for 3 years. More investigations with ultrasonographic study and magnetic resonance imaging demonstrated the presence of a fistula between the kidney and skin. Detailed laboratory workup was negative for the diagnosis of renal tuberculosis. This patient was considered as a rare variant of xanthogranulomatous pyelonephritis and was managed effectively with a simple nephrectomy.