What this probably does is enumerating the followings for the target user, then opening a filter stream [1] that watches a list of all of those.
[1] https://dev.twitter.com/streaming/reference/post/statuses/fi...
[1] https://dev.twitter.com/streaming/reference/post/statuses/fi...
Their architecture is described here: https://github.com/agermanidis/Antipersona/blob/master/ARCHI...