Akzeriuth is a crater-like city surrounded by natural walls, similar to Baticul. However, unlike Baticul, which ascends into the sky, Akzeriuth descends into the earth and contains numerous mine shafts for excavation purposes. The minerals surrounding the area of Akzeriuth are highly-valued raw materials needed to make various weapons and armor. Because of this, the area has been embroiled with many political conflicts over its control, namely between Kimlasca and Malkuth. Despite being Malkuth's territory now, the city was once governed by Kimlasca. Akzeriuth has a relatively small population of 10,000 workers and their families.
Prior to the events of the story, Akzeriuth was facing a crisis due to a poisonous gas known as the miasma enveloping the area, particularly deep within the mines. Luke and his companions travel to Akzeriuth as a rescue party at the behest of Emperor Peony due to the current crisis it faces. Kimlasca feels that, if it were to save Akzeriuth, it would be a positive step toward the establishment of a peace treaty. Since the road to the city on the Malkuth side is unusable, the group journeys through Deo Pass. Upon reaching Akzeriuth, the group meets with Pyrope, a local supervisor, who informs them that Dorian General Van Grants has already proceeded into the mine with the vanguard unit. However, when Luke and the others prepare to enter the mine, a soldier of the Oracle Knights appears and calls Tear Grants to investigate the possible discovery of the Seventh Fonstone. Tear leaves the group in order to confirm the report's authenticity while the others proceed into the mine for the rescue operation.
Luke and the others make their way to the deepest portion of the mine, discovering many people collapsed due to the miasma. The groups attempts to help the victims, but Luke ignores them and proceeds into he mine with Fon Master Ion to find Van. When they reach him, he is standing near the Daathic seal protecting the entrance to the Sephiroth Tree. Upon Van demanding Ion open the door, Ion hesitates but then cooperates due to Luke's plea. Van tells Luke that his hyperresonance will clear the miasma from the city, and as he told him earlier, make him a hero to Kimlasca. Luke trusts him, but in doing so, causes Akzeriuth to collapse into the Qliphoth, killing thousands. Van escapes while the others fall along with the city, surviving only due to Tear's Fonic Hymns. The group then boards the Tartarus, which is still operational, and travels to Yulia City, the only settlement within the Qliphoth.
It is later revealed that this destruction of Akzeriuth was foreseen in the Yulia Jue's Score, and that Luke's destruction of Akzeriuth would lead to open warfare between Kimlasca and Malkuth, followed by unprecedented prosperity for Kimlasca. Due to this knowledge of future events, Grand Maestro Mohs orchestrated the events that led to Luke's arrival at Akzeriuth, where Van would use his hyperresonance to destroy the Sephiroth Tree and the surrounding area. However, unknown to Mohs, Van had already diverted Mohs's plans to bring the Score to fruition by replicating the original Luke fon Fabre in his youth and allowing the replica to take his place as an expendable tool that would perish during the Akzeriuth disaster.