Hidden in the Metadata: Stealth Poisoning Attacks on Multimodal Retrieval-Augmented Generation

While multimodal retrieval-augmented generation (RAG) systems increasingly rely on images as external knowledge sources, the introduction of poisoned visual evidence can severely compromise multimodal large language model (MLLM) generation. Unlike prior attacks that rely on altering textual metadata, we introduce Vis-Poison, a novel visual knowledge poisoning attack where the poisoned image itself is the attacker-controlled payload, without manipulating captions, summaries, metadata, or other associated text. Specifically, this attack is instantiated through an automated multi-agent method that constructs visually plausible poisoned images. To assess its impact, we evaluate Vis-Poison across two representative multimodal RAG pipelines, four embedding models, and six generation models. Empirically, Vis-Poison achieves an end-to-end attack success rate of 40.16% to 65.40% against 30k-entry multimodal knowledge bases in black-box settings. Moreover, Vis-Poison remains effective against various MLLMs that can answer correctly from parametric knowledge alone, with an average success rate above 60%. Code and data are available at https://github.com/SWUFE-DB-Group/Vis-Poison.

Retrieval-augmented generation (RAG) is a widely adopted paradigm for enhancing LLMs in medical applications by incorporating expert multimodal knowledge during generation. However, the underlying retrieval databases may naturally contain, or be intentionally injected with, adversarial knowledge, which can perturb model outputs and undermine system reliability. To investigate this risk, prior studies have explored knowledge poisoning attacks in medical RAG systems. Nevertheless, most of them rely on the strong assumption that adversaries possess prior knowledge of user queries, which is unrealistic in deployments and substantially limits their practical applicability. In this paper, we propose M\textsuperscript{3}Att, a knowledge-poisoning framework designed for medical multimodal RAG systems, assuming only limited distribution knowledge of the underlying database. Our core idea is to inject covert misinformation into textual data while using paired visual data as a query-agnostic trigger to promote retrieval. We first propose a unified framework that introduces imperceptible perturbations to visual inputs to manipulate retrieval probabilities. Besides, due to the prior medical knowledge in LLMs, naively poisoned medical content with explicit factual errors can be corrected during generation. Thus, we leverage the inherent ambiguity of medical diagnosis and design a covert misinformation injection strategy that degrades diagnostic accuracy while evading model self-correction. Experiments on five LLMs and datasets demonstrate that M\textsuperscript{3}Att consistently produces clinically plausible yet incorrect generations. Codes: https://github.com/ypr17/M3Att.

Multimodal Retrieval-Augmented Generation (MRAG) has emerged as a reliable and cost-effective technique of grounding the generative capabilities of Multimodal Large Language Models (MLLMs) into relevant, up-to-date, external knowledge. Despite presenting several benefits, such as reducing hallucinatory behavior, they also introduce new attack surfaces, including leakage of private information and vulnerabilities against data extraction attacks. In this paper, we introduce $\immrag$, an adaptive and automatic data extraction attack procedure operating in a black box setting against image-returning MRAG, a configuration in which the retrieved visual artifact is itself the response. Each query blends an attacker-held shadow image with an image already recovered from the system, and relevance-weighted resampling steers subsequent queries towards regions of the embedding space that still yield novel retrievals. Unlike current extraction attacks that aim to persuade the model towards data leakage by placing a malicious query as a textual prompt, $\immrag$ embeds the malicious instructions inside a user-given input image. We evaluate $\immrag$ on three plausible and distinct real-world scenarios: medical assistant, document-focused helper and general purpose tool. The experiments involve the study of the effectiveness of the attack on multiple CLIP-family retrievers, as well as the impact of various generators. A single 2500-query run reconstructs up to 611 distinct radiology images, 566 document scans and 416 general-purpose images under local-feature correspondence, and reaches up to $5.6\times$ as many distinct datastore items as a non-adaptive baseline. Our results show the urgent need for safeguards specifically designed for multimodal data.