Retrieval-augmented generation (RAG) is a widely adopted paradigm for enhancing LLMs in medical applications by incorporating expert multi-modal 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 M³Att, 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 M³Att consistently produces clinically plausible yet incorrect generations. Codes: https://anonymous.4open.science/r/M3Att.

This study introduces the Semantic Textual Similarity Pseudo-Label Semi-Supervised Clustering (STSPL-SSC) framework. The STSPL-SSC framework is designed to tackle the prevalent issue of scarce labeled data by combining a Semantic Textual Similarity Pseudo-Label Generation process with a Robust Contrastive Learning module. The process begins with employing k-means clustering on embeddings for initial pseudo-Label allocation. Then we use a Semantic Text Similarity-enhanced module to supervise the secondary clustering of pseudo-labels using labeled data to better align with the real clustering centers. Subsequently, an Adaptive Optimal Transport (AOT) approach fine-tunes the pseudo-labels. Finally, a Robust Contrastive Learning module is employed to foster the learning of classification and instance-level distinctions, aiding clusters to better separate. Experiments conducted on multiple real-world datasets demonstrate that with just one label per class, clustering performance can be significantly improved, outperforming state-of-the-art models with an increase of 1-6% in both accuracy and normalized mutual information, approaching the results of fully-labeled classification.