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Critical care nurse here. The answer is esophageal varices.

It's the same physiological anomaly as hemorrhoids, except in your esophagus. Swollen, fragile veins caused by increased internal pressure. In the case of hemorrhoids, that pressure inside the veins is caused by straining too much when trying to poo. In esophageal varices, the increased pressure inside the esophageal veins comes from blood backing up from a swollen, scarred, and damaged liver. So we often see esophageal varices in end stage alcohol use disorder.

Horror stories abound in emergency departments and ICUs of having to do CPR on a patient massively hemorrhaging out of their mouth from esophageal varices. As soon as nurses I know saw this report, our immediate thought was, "Yep, varices."

https://my.clevelandclinic.org/health/diseases/15429-esophageal-varices

I forgot the medical term but when you have a REALLY bad liver the blood starts to take other ways to the heart to circumvent it (kollateral paths).

One path is going through your oesophagus so your venes widen very much. With the widening the risk of a rupture starts to increase very much and as soon as it does, there is nothing much that can save you.

I am not saying he got that but the description fits very much on point.

Obviously I doubt this but it's a final phase of ebola.

Disseminated intravascular coagulation, it's when you get a bunch of clots, that uses up all your platelets, and you bleed out because you can no longer clot.

For real, I need a plausible explanation

Ebola virus?

Oddly enough, alcohol abuse. It’s called esophageal varices.

It’s basically caused by veins in your esophagus rupturing. The same way you can have veins hemorrhage near your anus, causing hemorrhoids. In your esophagus, it’s usually caused by an enlarged liver putting pressure on the surrounding veins. And an enlarged liver is usually caused by end-stage alcoholism.

So the dude had an enlarged liver, (likely sue to a lifetime of alcohol abuse,) popped veins in his esophagus, and started coughing up massive amounts of blood. The dude likely wouldn’t have survived even if he was sitting in an ER when it happened. By the time it happens, it’s usually too late to fix; The victim will drown in their own blood before doctors have a chance to fix it.

But as a random onlooker with no idea what’s happening, it’s absolutely horrifying to see. It looks like something straight out the beginning of a zombie movie. Hell, even if you know exactly what’s happening, it’s still horrifying to see. But at least if you recognize it, you know it’s not contagious.

Source: Dated an EMT for a while, and she had a patient deal with one right after we started dating. I got morbidly curious, and regret the ensuing google searches.

I want to know too

Imagine being that guy dying, listening to you scream your brains out in his final moments.

Ruined clothes 😱

That's the show, thank you! I was thinking X-Files but I just knew it was wrong.

If I was in the plane, I would be like "yep, it's a coin toss between zombies or the strain."

That was my thought too. A portal hypertensive crisis following exertion leading to rupture of varices. I can't think of much else that would present like that besides maybe Ebola Zaire or something, but that would have a noticeable prodrome and "coffee grounds" in the emesis.

You are shitting me.

Well, Business Insider did link to flightradar, which shows that the flight in question (they said this past Thursday, which was the 8th) did in fact divert and return to the originating airport at Bangkok on that day. Which isn't necessarily great evidence, but it's better than nothing.