Vis-Poison: Poisoning Visual Knowledge in Multimodal Retrieval-Augmented Generation

Retrieval-augmented generation (RAG) has emerged as a powerful paradigm for enhancing multimodal large language models by grounding their responses in external, factual knowledge and thus mitigating hallucinations. However, the integration of externally sourced knowledge bases introduces a critical attack surface. Adversaries can inject malicious multimodal content capable of influencing both retrieval and downstream generation. In this work, we present MM-MEPA, a multimodal poisoning attack that targets the metadata components of image-text entries while leaving the associated visual content unaltered. By only manipulating the metadata, MM-MEPA can still steer multimodal retrieval and induce attacker-desired model responses. We evaluate the attack across multiple benchmark settings and demonstrate its severity. MM-MEPA achieves an attack success rate of up to 91% consistently disrupting system behaviors across four retrievers and two multimodal generators. Additionally, we assess representative defense strategies and find them largely ineffective against this form of metadata-only poisoning. Our findings expose a critical vulnerability in multimodal RAG and underscore the urgent need for more robust, defense-aware retrieval and knowledge integration methods.

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 agentic retrieval-augmented generation (RAG) systems expand the attack surface beyond prompt injection to include text poisoning, image injection, direct-query attacks, and orchestrator-level tool manipulation. Existing red-teaming approaches are typically surface-specific and often recycle known attack templates; on text-poisoning benchmarks we measure 73-84% exact duplication. We present MIRROR, a unified cross-surface framework that performs memory-guided Monte Carlo tree search while conditioning candidate generation on retrieved context under an explicit novelty constraint. A deterministic Novelty Gate rejects any candidate matching the retrieval set under normalized comparison, allowing retrieval to inform search priors without enabling prompt copying. Across four attack surfaces on a multimodal agentic RAG target, MIRROR attains 76% ASR on image poisoning compared with 52% for baselines, 97% ASR on orchestrator attacks at half the query cost, and the lowest cross-surface variance (coefficient of variation 0.47). In contrast, specialized baselines collapse across surfaces: suffix optimization reaches 79% ASR on text poisoning but 1% on direct queries. We release ART-SafeBench with 41,815 in-package records and runtime adapters yielding 41,991+ total records across four surfaces.