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The first quest in Act IV can be activated by talking to Tyrael:

Tyrael
There is a dark, tortured soul who was trapped within this forsaken realm long ago. He was called Izual by mortal men, and in ages past he was my most trusted Lieutenant.

Yet, against my wishes he led an ill-fated assault upon the fiery Hellforge, itself.

Despite his valor and strength, Izual was captured by the Prime Evils and twisted by their perverse power. They forced him to betray his own kind and give up Heaven's most guarded secrets.

He became a corrupt shadow of his former self - a fallen angel trusted neither by Heaven nor Hell.

For his transgressions, Izual's spirit was bound within the form of a terrible creature which was summoned from the Abyss. His maddened spirit has resided within that tortured husk for many ages now.

It seems to me that he has suffered long enough. I implore you, hero, find Izual and release him from his cruel imprisonment.

Put an end to his guilt and suffering.
DII Icon The Fallen Angel.png The Fallen Angel
Look for Izual in the Plains of Despair.

If you talk to Tyrael or Deckard Cain before leaving, or return after activating this quest by finding Izual in the Plains of Despair:

Tyrael Deckard Cain
Though Izual no longer carries the Angelic Runeblade, Azurewrath, he may still possess great strength and power within his new form.

Also, he may not be able to tell friend from foe while in his present state. If you find him, he will almost certainly be hostile.

Proceed with the utmost caution.
Tyrael has asked you to confront Izual the Fallen? He must have great faith in your abilities!

I trust you know what you're doing... Be careful. You're our last hope.

This quest is optional, but it's well worth completing. The Plains of Despair are just beyond the Outer Steppes, which are at the bottom of the stairs leading down from the Pandemonium Fortress beyond the gateway in its southeast wall.

Outer Steppes

The Outer Steppes are randomly populated by three of the following six monster types: leaping Cliff Lurkers, corpse-spitting Corpulents, mana-draining Doom Casters, Doom Knights, Flesh Spawners (which spawn Flesh Beasts) and fire-breathing Venom Lords. There are also Trapped Souls.

The Pandemonium Fortress is on its northwest side and the entrance to the Plains of Despair is on the perimeter of one of the three other sides: since the stairs down from the Fortress take you to the west corner of the Steppes, it's best to travel right upon entry (even if the entrance is on the northeast side, it's likely to be close to the east corner).

Plains of Despair

The Plains of Despair are similarly populated to the Outer Steppes, except lightning-casting Burning Souls replace Cliff Lurkers. The entrance to the City of the Damned is on the perimeter of one of the three other sides: if you find it before Izual, you may want to enter, search for and activate its waypoint before returning to the Plains (it's next to the stairs down to the River of Flame).

Izual

Boss Animal

Save yourself!

This quest is activated when you approach Izual if talking to Tyrael has not already done so:

DII Icon The Fallen Angel.png The Fallen Angel
Destroy the demon that holds Izual's soul.

If you return (again) before destroying the 'demon':

Tyrael Deckard Cain
You mustn't delay, mortal hero. Izual must be put to rest, but Diablo still lurks within this realm.

Go now... Hurry!
Having trouble finding the Fallen Angel, eh?

You'd better hurry. It's beginning to feel like some great evil is permeating the air around here.

Izual is a melee attacker who can cast Frost Nova. He isn't particularly dangerous and he never has any Unique bonuses, but it can take a while to destroy his host without Crushing Blow or Static Field to reduce its life by a percentage rather than an absolute amount. Once you've done so, Izual's spirit is released and any other monster in the vicinity is killed (although no experience is received for these).

DII Icon The Fallen Angel.png The Fallen Angel
Talk to Izual's Spirit.

You don't need to do this, but you might as well:

Izual
Tyrael was a fool to have trusted me!

You see, it was I who told Diablo and his Brothers about the Soulstones and how to corrupt them. It was I who helped the Prime Evils mastermind their own exile to your world.

The plan we set in motion so long ago cannot be stopped by any mortal agency. Hell, itself, is poised to spill forth into your world like a tidal wave of blood and nightmares.

You and all your kind... are doomed.
DII Icon The Fallen Angel.png The Fallen Angel
See Tyrael for reward.

If you talk to Deckard Cain:

Deckard Cain
You're lucky to be alive, my friend! It is imperative that you find and stop Diablo!

You should speak of this with Tyrael. He will know what to make of this.

See Tyrael for your reward: two skill points!

Tyrael
Thank you, hero, for putting Izual's tortured spirit to rest. May the Light protect you and the powers of Heaven shine upon your path.

But, if what you tell me is true, then I fear that we have been played for fools all along.

Izual helped Diablo and his Brothers trick me into using the Soulstones against them... Now the Stones' powers are corrupted.

With the combined powers of the Soulstones under their control, the Prime Evils will be able to turn the mortal world into a permanent outpost of Hell!
DII Icon The Fallen Angel.png The Fallen Angel
Quest completed.
DII Icon The Fallen Angel.png The Fallen Angel
You completed this quest in a previous game.