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Pat the shrimp dry and season with salt, black pepper, and red pepper flakes.
Melt the butter in a large skillet over medium-high heat. Add the shrimp and cook for about 2 minutes per side.
Measure the shrimp at the center with a food thermometer; continue cooking until it reaches at least 63°C/145°F. Transfer the shrimp to a plate.
Reduce the heat to medium. Add the garlic and tomato to the skillet. Cook for 2–3 minutes, until the tomato softens.
Stir in the cream, cream cheese, pesto, and lemon juice. Simmer gently until the sauce is smooth; do not let it boil hard.
Return the shrimp to the skillet and sprinkle in the grated cheese. Toss gently until everything is hot and coated.
Serve immediately.
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