Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 2 1 2017 08 26 21 23 EN Seyed Hassan Inanloo Department of Urology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Seyed Reza Yahyazadeh Department of Urology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Ali Fallah Department of Urology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2017 03 09 2017 06 07 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. https://crcp.tums.ac.ir/index.php/crcp/article/view/108 https://crcp.tums.ac.ir/index.php/crcp/article/download/108/69