Sarcoptes scabiei was detected for the first time in skin scrapings, hair pluckings, and histologic sections from a blue sheep (Pseudois nayaur) from the Shimshali Pamir in the Karakorum range of the western Himalaya in Pakistan (36°28′N, 75°36′E). Local reports suggest many hundred animals have been affected by a severe skin disease over a 10-yr period, but the shy nature of this species and the extreme climate that they inhabit meant only a single affected animal was available for detailed evaluation. The severe skin lesions were confined to the forelegs and brisket, and many Sarcoptes scabiei mites were present in all the samples examined. Histologic preparations of the skin showed hyperkeratotic and parakeratotic hyperkeratosis of the epidermis with a severe exudative dermatosis with many polymorphonuclear neutrophils and gram-positive cocci, yet no eosinophils. These findings might suggest the lack of an appropriate immune response to the parasite or other coping strategies because there has been no abatement of the clinical signs in affected animals over several years. Treatment options are limited due to the behavior of the species and its habitat. The blue sheep is a primary source of prey for the endangered snow leopard (Panthera uncia) and continued depletion could have serious consequences for the survival of the latter.