Heat a splash of olive oil in a large saucepan over medium heat. Add finely chopped shallots and sauté until softened, about 3–4 minutes.

Stir in the fresh sage, minced garlic, and a pinch of crushed red pepper flakes. Continue to sauté until fragrant, around 4–5 minutes.

Add the tomato paste and canned pumpkin purée, stirring well to combine. Cook gently over medium heat for about 5–7 minutes.

Pour in the vodka, scraping up any browned bits from the bottom of the pan. Allow it to simmer for about 3–4 minutes.

Reduce heat to low and stir in the heavy cream, grated Parmesan cheese, and ground nutmeg, cooking for an additional 2–3 minutes.

Cook the fusilli pasta in a large pot of salted boiling water according to package instructions, typically 8–10 minutes.

Add the drained fusilli to the pumpkin sauce and toss gently. Adjust consistency with reserved pasta water if necessary.

Plate immediately, garnishing with extra Parmesan cheese or crispy sage leaves.