MSRA-0922

MSRA-0922

A 7-year-old boy is brought to the Emergency Department in December because, for the past three days, he has had a high fever (up to 40 °C), vomiting and night sweats. For the last four weeks, he has been lethargic and has sweated through his pyjamas almost every night. He has had several nosebleeds in this time period, which his parents attributed to dry air from the heater. He has also been complaining that his back hurts.
On examination, his temperature is 39.5 °C, his heart rate 140 beats per minute, his blood pressure is 80/60 mmHg and his respiratory rate 20 breaths per minute. He appears acutely ill, and you notice small petechiae on his abdomen.
Which one of the following would an examination of peripheral lymphocytes most likely show?